QEEG-guided, z-score and LORETA neurofeedback

Domain IX · Biomedical, neuro & digital · Robert Thatcher, Congedo, Joffe · 2004

What it is

This entry covers three overlapping ways of choosing and running EEG neurofeedback from a multi-channel brain map rather than from a fixed, symptom-based protocol:

Format

• Session counts: reported figures, not prescriptions. ISNR asks that session estimates be realistic and decided jointly; it notes ADHD research commonly cites 40–50 sessions and discourages promising lasting results after few sessions. The z-score developers report score reductions in "10 sessions…

Who practises it, and how they are trained or regulated

• Format. Individual, in-office sessions with the practitioner present; ISNR treats leaving clients alone for much of a session, as in "treatment mill" settings, as below standard. Home or remote training only after in-office evaluation and sessions, under licensed supervision.
• Version followed: the International Society for Neurofeedback & Research (ISNR) position papers on QEEG standards (Hammond et al., 2004) and on standards of practice (Hammond et al., 2011) for the clinical frame; Thatcher, Lubar & Koberda (2019) for live z-score and LORETA z-score training as its developers describe it; Congedo, Joffe & Lubar (2004) for the first LORETA (tomographic) neurofeedback pilot; Coben,…
• QEEG-guided neurofeedback: a quantitative EEG (QEEG) is recorded, compared with an age-matched normative database, and the deviations are used to individualise an otherwise conventional protocol (amplitude training of the kind in 045–049). ISNR describes guiding training as the main purpose of QEEG for neurotherapists, whereas neurology and psychiatry use QEEG mainly as a diagnostic aid for medical pathology.

Evidence status, as the guide reports it

• Session counts: reported figures, not prescriptions. ISNR asks that session estimates be realistic and decided jointly; it notes ADHD research commonly cites 40–50 sessions and discourages promising lasting results after few sessions. The z-score developers report score reductions in "10 sessions…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• How do you and the practitioner understand what is happening, in spiritual or cultural terms? Is that a source of comfort, worry, or both?
• Does it use a device, heat, cold, water or a physical procedure? Has a medical professional checked that it is safe for you?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• Side effects, symptom worsening, low engagement.
• Unsupervised use, sharing equipment, protocol changes at home.
• Improvement only in session data; clients attributing change only to the machine.
• Split messages between providers; the client stopping effective treatment in favour of training.
• Many "significant" scores in a large array (expected by chance); medication effects; age mismatch.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.