Smarter Brain Training

Advancements in Neurofeedback Provide New Solutions

Deborah Simkin, M.D., is one of the few psychiatrists in the Panhandle that practices a complementary and integrative approach. In addition to her board certification in child, adolescent and adult psychiatry and her interest in sports psychiatry, Simkin is a diplomate with the American Board of Integrative and Holistic Medicine. Her practice incorporates cognitive behavioral therapy, nutritional and herbal supplements, meditation, medical intervention as needed and neurofeedback (NF).

How Neurofeedback Works

Brainwaves are categorized according to their frequencies, or bands, which are measured in hertz (Hz), or cycles per second. Overall brain activity is a mix of all types of brainwaves at the same time, some in greater quantities and strength than others. In people dealing with challenges related to the central nervous system—such as anxiety, attention deficit and hyperactivity disorder (ADHD), autism, depression, post-traumatic stress disorder (PTSD), seizures, sleep problems, traumatic brain injury (TBI) and others—patterns of brainwaves differ from those of normal brains.

There are many types of NF. Simkin specializes in a type that uses low-resolution electromagnetic tomography (LORETA) to map the brainwaves in deep within specific areas of the brain rather than in neurons only on the surface of the brain (as with other forms of NF). A quantitative electroencephalogram, or qEEG, is used to record a patient’s brainwaves and compare them against a database of an age-matched sample population of people. A statistical measure called a Z-score provides a range of data that is considered normal. The comparison allows Simkin to identify outliers, or abnormal patterns of brainwaves, that are precisely linked to symptoms of the particular brain dysregulation the patient is experiencing. These brainwaves that appear to be outliers, or abnormal, can be targeted and normalized.

In attempting to resolve a particular issue, NF trains the brain to regulate itself and achieve a balance of brainwaves that are within the normal range, because they are stable and efficient in processing information in brain networks related to the patient’s symptoms.

NF relies on the process of operant conditioning, which means that when a specific, desired brainwave frequency occurs, a reward is provided. “The electrical pattern soon begins to appear in anticipation of the reward, which leads to it appearing more often,” explains Simkin, "In this way; the brainwave activity is shaped toward more desirable and regulated performance. This self-regulation training allows the intervention to occur from the inside out, rather than from the outside in, as is the case with medication. Therefore, side effects are minimal. In addition, research has shown, although the studies are small, that even after neurofeedback has been completed, its effects are lasting and even continue to improve.”

What to Expect as a Neurofeedback Client

Before NF is done, Simkin conducts a thorough bio-psycho-social evaluation to rule out any other processes or conditions that may mimic the issue being treated. This evaluation may involve testing for genetic markers, nutritional deficiencies, learning disorders, inflammatory processes (allergies) and other co-morbid conditions such as endocrine disorders. The results may indicate that other interventions, such as family therapy or substance abuse treatment, need to be addressed before proceeding with NF.

The LORETA Z Score NF (LZNF) process requires patients to first undergo an EEG with eyes opened and also closed. The qEEG is established by comparing the brainwaves of the patient to a normal database. Any patterns of brain waves that differ significantly from the mean average are identified. If the abnormal patterns of brainwaves occur in the area of the brain where the symptoms are known to occur, they are targeted during LZNF.

During the NF session, the client is viewing a screen and when the correct brainwave patterns occur, the brain is rewarded with a reinforcement (like a dot appearing or a race car moving on a track). Eventually, the patient will subtly learn how to produce the brainwave pattern and whenever this happens, the reward appears. The length of time the patient must hold the correct brainwave before receiving the reward is lengthened until the brainwave moves more towards normal.

 The Effectiveness of LORETA Z-Score Neurofeedback

Simkin adds that LZNF is superior to many other forms of NF. “LZNF allows me to more accurately locate the abnormal patterns using three-dimensional source localization, where the mixture of frequencies under each scalp electrode is accurately unscrambled and linked to three-dimensional sources deep within the interior of the brain, much like what is seen on an MRI,” she explains. “Hence, LZNF can reach deeper structures in the brain so that the treatment to normalize them can be more precise and completed in an average of 10 to 20 sessions, as compared to the other types of NF, which may require as many as 80 or more sessions. LZNF also allows me to train region-specific brain activity or entire brain networks (for instance, entire brain circuits involved in ADHD). The technique also addresses, if there is too little or too much electrical activity between two areas deep in the brain (often found with learning disorders, autism, PTSD and TBI), which clinicians call ‘coherence’, and if electrical activity is moving too fast or too slow within two areas deep in the brain, which we call ‘phase’. All of these are crucial factors in optimum brain functioning.”

Few clinicians are trained in the new techniques used for LZNF. They must be trained in LZNF neurofeedback or supervised by a certified clinician trained in those techniques (with appropriate neurobiological background) in order to ensure that proper NF protocols are developed. This ensures that for instance, abnormal pathological brainwaves (and not abnormal brainwaves that actually may be an asset to a patient) are targeted.


Location: 4641 Gulfstarr Dr., Ste. 106, Destin. For more information, call 850-243-9788 or visit


Lauressa Nelson is a contributing editor for Natural Awakenings magazines throughout the country.

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