The Length of Neurofeedback Training

Many people are surprised by the recommendation that at least 40-60 sessions of neurofeedback are needed to obtain lasting positive changes in the brain. Are these same people surprised that it takes many hours of careful physical effort to build up a healthy, muscular physique? Would they also be shocked that it takes most people years of concentrated study to earn an advanced university degree?

I would argue that just the opposite is true—it is surprising that only 40-60 sessions of neurofeedback is adequate to achieve lasting positive changes for most people! After all, the brain is an extremely complex organ that is so intricate that we are still in the early stages of exploring its functions. Even though the 10,000 hours of practice “rule” to become truly expert at a skill has been debunked, there is no doubt that lots of high-quality and disciplined practice is necessary to acquire an ability (

Neurofeedback using the Othmer method guides the brain towards the ability of calm and well-ordered function. During each session, the patient is asked to make better and better approximations towards desired brain states. The therapist, acting as a coach or teacher, is an essential part of the process since she determines the areas of the brain to be trained, evaluates the response to training, and then adjusts the neurofeedback accordingly. The goal of neurofeedback is to create default brain functioning that is controlled and orderly.

Within an individual session of neurofeedback, the brain often shows changes in its electrical activity over seconds to minutes of effort. However, there is a marked difference between the short-termed “learning” that occurs over a session with the long-term expertise that happens with repeated sessions of neurofeedback. The brain redevelops its “physique” and functioning just like an athlete develops the proper musculoskeletal physique, muscle memory, and mental state over months to years of practice and being well coached to excellent performance. New neuron-to-neuron connections with appropriate neurotransmitters are made in response to repeated practice. As newer and better brain pathways are reinforced, old, poorly functioning pathways are weakened and pruned. Practice over extended periods of time enables these types of structural changes of the brain. Repetition of healthy brain tasks via neurofeedback complemented with excellent brain maintenance in everyday life confers long-term brain health and function. The website,, has explanations of memory formation that describe the formation of long-term changes such as those induced via neurofeedback.

Some brain conditions such as autism can be so complex that many more sessions than the average may be required to enable improved brain performance. Some patients benefit from occasional “touch up” sessions to maintain effective brain operation.

Complex Issues of the Brain Usually Have Complex Solutions. The Fallacy of using medication for the treatment of ADD/ADHD.

The brain is an extremely complex organ that functions in ways that we are just beginning to understand. Issues of focus and attention are the result of many potential causes that include:

Adverse effects from medication use

Allergic rhinitis


Food sensitivities




Lead toxicity


Sensory impairment, like vision or hearing

Brain injury

Developmental delays

Learning disability

Intellectual disability

Seizure disorder

Sleep disorders

Speech or language problems


Conduct disorder


Obsessive-compulsive disorder

Oppositional defiant disorder

Posttraumatic stress disorder

Substance abuse

Child neglect

Physical or sexual abuse

Parenting issues


Improper learning environment

Parental psychopathology or substance abuse

Social skills deficits

Sociocultural factors

So why are people with attention issues quickly labeled as ADD or ADHD and placed on medication in the USA? This is certainly not the case in most of the rest of the world. Many advanced countries report low or virtually no incidence of ADD/ADHD.

I would argue along with many other clinicians in the US that attention problems are being pathologized with little examination of potential underlying causes. Then those with attention problems are placed on medicine with the mistaken notion that doing something so simple is the solution for a condition that is usually the consequence of many influences on the brain.

 Evidence is mounting for ADD/ADHD drugs having positive effects only for a few weeks. These same short-term improvements of improved focus, memory, and energy levels are felt in almost anyone who takes medication, both “normal” and ADD/ADHD-diagnosed subjects.   As data from long-term studies is analyzed, no differences in behavior can be discerned in continuously medicated children versus non-medicated children at both 3 and 8 years. Medicated children have no advantage in academic performance, flexibility in thought for complex tasks, peer relationships, antisocial behavior, substance abuse, or arrests. In fact, medicated kids have a higher drop out rate from high school and worse relationships with their parents versus non-medicated kids. Medicated boys trend towards worse academic performance. Medicated girls tend to have more emotional problems.

 Problems with medication for ADD/ADHD are well known, and include:

 Decreased appetite

Sleep problems








Growth retardation

Cardiac arrhythmias, hypertension and other cardiovascular issues

Rebound symptoms as medications wear off

Withdrawal symptoms when attempts are made to discontinue medication

 So how have an estimated 15% or 6.5 million American children ended up diagnosed as being ADD/ADHD, and an estimated 3.5 million of them placed on medication? First of all our care system routes children with attention problems into the medical system where attention issues are generally perceived as a biological disorder of biological causes as opposed to a medical condition, psychosocial condition, a condition of differently paced brain maturation, or a mix of these. Our current medical models reward “efficiency”. This means a short, screening visit possibly followed by family and school questionnaires to confirm an attention problem. Then a prescription is written. A follow-up appointment in a few weeks might confirm that the medicated patient is quieter and more focused. However, almost anyone placed on ADD/ADHD medication will also be more focused in the short run, too. Thus begins years of medication, and neglect of identifying and remediating the underlying causes of the attention problem.

 Placing kids on drugs give a sense of “doing something” about the issue of attention. Medical providers, families, and schools are looking for a simple fix for a complex brain issue. The mistaken impression that popping a pill is going to solve the issues of someone with attention problems is passing the buck on meaningful treatment. This causes a great disservice to those with attention problems, their families, and society at large since many do not go on to get the attention in school, psychosocial treatment, and other treatments like EEG neurofeedback that have been proven to treat attention disorders as well as behavioral issues on a long term basis.

 I try to look at each person who comes into my practice with attention problems as their own unique case. It is important to tease out the important contributions to an inability to focus well and consistently. Then I try to help that person and their support system to prioritize and deal with the factors that seem to be driving the problems that they present with.

 EEG neurofeedback is an important component of this treatment. However, most patients benefit from a thorough re-evaluation of their psychosocial milieu. Circumstances that promote inattention need to be recognized. Just like neurofeedback does not change brain function and architecture overnight, psychosocial interventions take time and practice. Neurofeedback and behavioral therapies are time-consuming, but long-term outcomes justify the additional effort. Those who prescribe and use medications for ADD/ADHD are using a Band-Aid approach that can cause more harm than good.

How long does it take for neurofeedback to work?

This simple question has a simple answer that needs much elaboration–it is different for each person, and I find it quite difficult to predict who will begin to respond within a few sessions and who will take considerably longer.  The usual person needs 40-60 sessions of neurofeedback to make meaningful and lasting changes.  However, there are factors that might be under the control of person receiving neurofeedback that can augment or counter the effectiveness of neurofeedback.

One of the first things to think about is brain nutritional support.  A diet that is rich in omega-3 fatty acids, a variety of vegetables and fruits, and whole foods is much more likely to foster good brain health than one that consists of fast foods, sugar, and manufactured foods that contain dyes, preservatives, and other additives.  I agree with the notion that the foods that look most like their sources are generally the healthiest.  For instance, whole grain bread looks much more like grain than white bread.  A ragu dish looks more like unprocessed vegetables than a pizza with pepperoni and tomato sauce.

A healthy diet also makes it unnecessary to take most dietary supplements in an otherwise healthy person.  Fad diets based on the latest research “uncovering” a new superfood are silly.  There are many healthy foods and getting a good variety is most sensible.

There are a couple of exceptions.  With the use of sun screens and the decrease in outdoors activities, many people are Vitamin D deficient.  A simple blood test can detect this. If needed, supplements are usually taken once a day.  Readily available sources of omega-3 fatty acids may also be difficult to locate and might not appeal to some palates.  So supplementation with omega-3 fatty acids can be helpful for many people.

Another way to impede progress with neurofeedback is spending excessive time on “screens”.  I lump television, video gaming, and (non-work, non-school) computer/smart pad use in this category.   The way that most of us use media allows our brains to relax in a relatively unfocused way.  Think of a baby with a pacifier or an idling car.  Some amount of this is alright for most, but spending long periods of time in this state makes it habitual and difficult to break away.  Productive and engaged brain states become more difficult.  I usually recommend limiting screens to an hour or less a day.

Regular physical exercise is essential for the health of the brain.  It increases blood flow to the brain providing more nutrients and oxygen.  It speeds the removal of carbon dioxide and waste products.  Aerobic activity for a least a half an hour and at least 5 days a week can make positive changes happen faster.

Getting enough sleep is of vital importance.  Young children need up to 12 hours of sleep per night.  The average teenager needs 9-9 1/2 hours of sleep per night–not just on weekends!  Adults need an average of 7-7 1/2 hours of sleep per night.  Sleep research has shown that adequate sleep is vital for a variety of metabolic activities.  Inadequate sleep promotes poor focus, mood disorders, and cancer.

Following regular routines is quite helpful for the brain.  As it becomes expert at following certain procedures, they become more and more automatic to the point that you might get many things done while barely thinking about them.   For example, when most of us first learn to drive a car, we tend to overuse the accelerator and brake pedals, oversteer, and forget to use our mirrors and peripheral vision.  Once these skills have been practiced enough, we hardly notice that we have them.  It seems like my car drives itself to my office.  So make a conscious effort to make regular tasks follow set patterns and schedules to free up your energies and brainpower for more worthwhile activities.

Positive behavioral incentives can work wonders.  Catch yourself or your loved ones being good and pay attention to it.  We are too quick to criticize and punish.  Emphasize the positive and correct!


I am in the unique position of being a family physician who specializes in alternative medical ways to improve brain performance.  EEG neurofeedback and biomedical techniques are my particular interests.  I hope to educate and advocate for brain health in this blog.  I welcome you questions and comments about topics that might interest you.

Doreen McMahon, MD