Neurofeedback Consent

Oregon Neurofeedback Information and Informed Consent

You have the option of including Neurofeedback in your treatment. Neurofeedback is a non-invasive treatment that works by engaging the brain’s own mechanisms of self-regulation. There are many varieties of neurofeedback. The method we use is ILF (Infralow Feedback).

WHAT IS NEUROFEEDBACK?

Neurofeedback is a treatment that taps into the brain’s own ability to regulate. There are different kinds of neurofeedback. The type of neurofeedback we will be using is called lnfralow Feedback (ILF). It has been used by many different types of people who seek to maximize their brain’s ability to function and can be used to treat a variety of symptoms including anxiety, mood disorders, poor attention, and sleeping problems.

HOW IT WORKS:

Like an EKG reads your heart waves, an EEG reads your brain waves. Your neurofeedback technician (which may include trained counselors and, from this point forward, will be referred to simply as “technician”) will place electrode sensors on your head using a washable paste. These sensors allow the neurofeedback EEG system to measure your brain-wave activity. While you watch a video, your brain wave activity changes the picture, sounds, and/or vibration of the screen and tactile stuffed animal. Your brain responds to that feedback activity and learns to maintain a more stable pattern on its own. No conscious effort is involved. Simply watch the video or play the game and your brain will figure out what to do.

The type of neurofeedback being used does not rely on a “one size fits all” approach. Assessment involves an exploration of many areas of health as well as mental and emotional performance. Protocols are individualized both in terms of where sensors are placed and what training frequencies are used. Your protocol is based on your history, symptoms, specific concerns, assessment data, and most importantly, on your response to the training. Your neurofeedback technician will need to ask questions before, during and after the training about physical and emotional symptoms and history to know which locations to train, when to change the frequency used to read your brain activity, and when to add or subtract an electrode location. The neurofeedback technician will test frequency levels to find those that work for your individual brain. Protocols are regularly adjusted to get the best effect. Each person is different, and no specific results are guaranteed.

SET YOUR OWN GOALS AND TRACK YOUR PROGRESS:

An important part of Neurofeedback is that you determine your goals with your neurofeedback technician. Typical goals include reductions in anxiety, muscle tension, and feelings of stress, and improvements in: sleep, focus or mood. Improvements are usually lasting and do not come at the cost of lessened creativity, mental dulling or lack of awareness. People often see improvements in areas they did not realize would benefit from neurofeedback. Also, since each person’s brain is unique, each person’s response to neurofeedback is unique and there is no guarantee that you will benefit. Your progress will be measured in several ways. You will be asked to identify the 3-5 symptoms or concerns you hope will improve with treatment. These should be concerns you can easily observe on a daily basis. At the beginning of each treatment session, you will be asked to rate those selected concerns. In addition, before beginning Neurofeedback and after every 20 sessions you may be asked about events in your life using either yes/no answers or a rating scale. When used, this test is repeated after every 20 sessions.

COMMUNICATING WITH YOUR NEUROFEEDBACK TECHNICIAN:

It is very important to report to your neurofeedback technician any and all changes in your behavior, mood and any other physical and emotional symptoms, either in the session, or between sessions, good or bad, even if they seem unrelated to the Neurofeedback. It is particularly important to track changes within 24 hours after a neurofeedback treatment session. After numerous studies spanning decades, there is no evidence that this form of neurofeedback has ever caused any serious, long-lasting negative effects. However, you may experience short-term negative effects such as headache, dizziness, tingling sensations, worsened sleep, negative feelings (i.e. anxiety, frustration, irritability), or low energy. It is also possible that you could experience no change or worsening of symptoms and/or behavior or exacerbation of medical conditions. If you experience any of these symptoms inform your neurofeedback technician right away and rest if needed. When you tell your neurofeedback technician of this, they can make the appropriate adjustments. These issues typically resolve quickly after the feedback settings/protocols are adjusted. If you experience exacerbation of medical conditions, inform your clinician right away and contact your physician as needed. Clients should be aware that some types of Neurofeedback (similar to counseling) could bring up painful memories, which may be part of the growth and healing process. Although rare, some professionals in this field report negative effects include headaches; negative feelings (i.e. anxiety, frustration, irritability, paranoia); unusual physical sensations (i.e. dizziness, fatigue, tingling sensations). In addition, skin irritation may occur from the electrode cream to prepare the skin and attach the sensors. Please inform your neurofeedback technician and/or physician immediately should any of the symptoms occur or if there are other concerns.

CONCERNS:

If following a training session, you feel confused, disoriented or lightheaded please inform your trainer and rest until you feel normal again; do not drive a vehicle or operate equipment until these symptoms subside.

MEDICATIONS:

It is important to notify your neurofeedback technician of all medications and supplements you are taking, as well as any changes in medication or your response to the medication. Because neurofeedback helps the brain work better, medications may need to be adjusted after beginning neurofeedback training. Never stop or change dosing of any medications without your prescribing doctor’s supervision. If you are receiving psychotropic medication your neurofeedback technician will require that a Release of Information form to be signed allowing the neurofeedback technician and doctor to communicate regarding your treatment when/if necessary.

OTHER FACTORS WHICH AFFECT NEUROFEEDBACK:

Notify your clinician of any and all changes in your life which may affect mood or performance, such as changes in medical diagnoses/symptoms, medications, substance use, stressors, or big life changes such as a change at school, work, or a loss.

WHAT IT IS NOT:

Neurofeedback is not a miracle cure for every condition. If you have a medical condition that requires medical treatment, neurofeedback is not an appropriate substitute. Neurofeedback is also often a helpful adjunct to other strategies. For example, if anxiety interferes with sleep, neurofeedback may reduce your anxiety, making it easier to implement sleep strategies. However, if you drink coffee at dinner, and watch exciting, loud TV shows at bedtime, neurofeedback alone may not improve your sleep. Your neurofeedback technician may also work with you to teach new skills and coping mechanisms to address concerns that cannot be treated by neurofeedback.

LENGTH OF TREATMENT AND PERMANENCE OF IMPROVEMENT:

Neurofeedback is a type of treatment that requires several individual sessions to achieve benefit. For many diagnoses (ADD without hyperactivity, anxiety disorders, simple depression, and common sleep problems), treatment typically requires 20 sessions, although improvements may be noticed after 2-3 sessions. While some may achieve the desired level of benefit with as little as 10-15 sessions, some may need as many as 40 or more to achieve the desired level of symptom resolution. Currently there is no way to precisely determine, prior to treatment, how many sessions will be necessary to achieve benefit, therefore clients are asked to plan on a minimum of 20 sessions of Neurofeedback prior to starting treatment. Effectiveness of the treatment will be re-evaluated after 20 sessions, and more sessions may be made available as needed and determined by the neurofeedback technician. Sometimes more severe issues require more sessions, and for some symptoms, “booster sessions” may be advised to maintain positive improvements gained. These types of sessions would be arranged in consultation with your neurofeedback technician.

SCHEDULING OF SESSIONS:

The neurofeedback portion of each session lasts approximately 30 minutes, with an additional 15–30 minutes for reviewing symptoms, discussing responses to training, and completing set-up and clean-up. For best results, sessions are recommended twice weekly for 10 weeks when possible, or at least once weekly to maintain consistent progress.

PAYMENT & FINANCIAL POLICY:

Oregon Neurofeedback does not accept insurance at this time. The single-session fee is $150, due at the time of service. Package options include a 10-session package for $1,250 and a 20-session package for $2,000, which offers a significant discount and is recommended for lasting change. Package fees must be paid in advance, and all fees are non-refundable unless otherwise agreed upon in writing. Optimal training typically involves two sessions per week for a minimum of 20 sessions.

NEUROFEEDBACK TECHNICIAN TRAINING AND CLINICAL SUPPORT:

Your neurofeedback technician and a Neurofeedback Supervisor will take part in online group supervision run by clinicians with years of experience with Neurofeedback. Your name will not be shared, just your age and gender/gender identity. The purpose of these discussions is to learn the best ways to use Neurofeedback for your benefit and for team learning.

FOR MORE INFORMATION ON NEUROFEEDBACK, PLEASE SEE THE BELOW VIDEOS AND LINKS:

EEG Info website: http://www.eeginfo.com/what-is-neurofeedback.jsp

The Brain Collective: https://www.thebraincollective.co.uk/what-we-do/infra-low-neurofeedback/

Neurofeedback Therapy explained Video: https://www.youtube.com/watch?v=JP71ZuE_EiY

BENEFITS AND RISKS OF NEUROFEEDBACK:

1. The benefits of Neurofeedback can include less tension and stress, improved sleep, improved focus, and improved mental and emotional self-regulation. Improvements are usually durable and do not come at the cost of lessened creativity, mental dulling or lack of awareness.
2. To the best of our knowledge there is no known evidence that Neurofeedback has caused any lasting or serious negative effects. However, both during and following a session, clients can feel more anxious, distracted, tense, restless, or have difficulty sleeping. These issues are typically quickly resolved as the feedback software settings are adjusted.
3. The neurofeedback technician will need to ask questions about physical and emotional symptoms to know which locations to train and when to add or subtract a location. The neurofeedback technician will test frequency levels to find those that work for your individual brain.

4. Each person is an individual and no specific results can be guaranteed.
5. Clients are expected to observe and report observations after each session to their neurofeedback clinician to guide the neurofeedback training. It is very important that you tell the neurofeedback technician of any:
6. Changes or negative effects in your behavior, mood and physical or emotional symptoms even if they seem unrelated to the Neurofeedback.
7. Change in any medications or your response to your medication so they can assess the impact on your Neurofeedback treatment.
8. Because ILF Neurofeedback helps the brain work better, medications may need to be adjusted as treatment proceeds. Do not stop or change any medication without talking to your doctor.

My neurofeedback technician and I have agreed to the following method of communicating between neurofeedback sessions if needed: I agree to report the effects of Neurofeedback and changes in my medications so the clinician can adjust treatment.

I understand these potential benefits and risks of Neurofeedback treatment.

By giving consent, you are also agreeing that your questions have been answered and you understand and agree to participate in Neurofeedback training.

I understand that there are usually significant improvements but that improvements in any individual cases cannot be guaranteed and depends on the willingness of clients to commit themselves to training and actively participate during Neurofeedback sessions. I further understand that some people do not improve, becoming worse before they become better; or may even, in rare cases, find their problems have worsened. I am willing to accept these risks.

I understand that psychotherapy, in addition to Neurofeedback, from a qualified clinician may be required as a condition to receiving Neurofeedback services; and that this requirement may arise after treatment has begun, and that Neurofeedback may need to be stopped until psychotherapy arrangements can be made.

I understand that data from my treatment will be used as a large, de-identified data set for analyses and publication. None of the data will reveal my identity.

I hereby release Oregon Neurofeedback LLC., Authentic Compassion Therapy, therapist, technicians and/or any of their sources of supervision, from any liability related to my or my child’s Neurofeedback training and agree to hold them, and/or their sources of supervision, harmless from any effects caused directly or indirectly from Neurofeedback.

Client Signature: ___________________________________Date:

Client Name: (please print)                    Client Date of Birth: ___________