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 (http://www.brainpickings.org/2014/01/22/daniel-goleman-focus-10000-hours-myth/).

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, http://thebrain.mcgill.ca/flash/i/i_07/i_07_p/i_07_p_tra/i_07_p_tra.html, 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.