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Neurofeedback: Understanding the Brain is an Integral Part of Healing the Mind
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Neurofeedback: Understanding the Brain Is an Integral Part of Healing the Mind

09/04/12
By Penijean Rutter-Gracefire, LMHC, CRC, BCN
Tampa, Florida

The incredible journey of psychotherapy over the last hundred years—built on inquiry, fueled by concern for quality of client care, and shaped by the authenticity and vulnerability of brilliant clinicians—has brought us to possibly the most exciting point in the history of mental health: true reintegration of the qualitative study of the mind with the quantitative study of the brain.

An overwhelming number of research studies have been published in the last decade linking cognition and emotion to brain regions and activational patterns. The study findings indicate how important it is for clinical mental health counselors to have a working knowledge of brain function when treating clients who present with disorders previously thought to be based “only” on emotional dysfunction or cognitive distortions. 

A recently published book, “The Emotional Life of Your Brain: How Its Unique Patterns Affect the Way You Think, Feel, and Live—and How You Can Change Them,
 by Richard Davidson, PhD, is a great read for practitioners looking to understand how emotional style is linked closely to recognizable patterns in individual brain activation.

As a licensed mental health clinician who has used brain imaging and neurofeedback in clinical practice for the last eight years, I find it nearly impossible to imagine creating a treatment plan for a client without taking a peek at what is going on behind the scenes when a client describes symptoms of anxiety, depression, or attention deficit disorder.

The Connection Between Brain and Behavior

My first job in the mental health field was as a contractor with the Florida Department of Corrections, rehabilitating drug and alcohol offenders using cognitive behavioral techniques. As anyone knows who has facilitated daily recovery groups with a population that is mandated to attend, and barely cooperative at best … Well, it’s a tough population to work with under any circumstances. And I was completely new, not just to the rehab beat, but to the world of therapy. I found being a young, inexperienced, five-foot tall female working with this demographic more than slightly challenging.

Determined to become a competent provider of services, I read everything I could get my hands on and grilled anyone who seemed to know anything about how people end up abusing substances, legal as well as illegal. This was my introduction into a world of traumatic brain injury, post-traumatic stress disorder, fetal alcohol syndrome, pervasive developmental delay, obsessive compulsive disorder, attention deficit difficulties, and many other conditions that directly affect how the brain uses its available resources to operate. 

The consistently observable connection between impact to a brain and the presence of symptoms often diagnosed as social, emotional, and cognitive disorders led me to search for an intervention that would more directly address the underlying neurophysiological issues that seemed to be influencing behavior. Although talk therapy helped many people I worked with, recovery was clearly limited when a client had a reduced ability to comprehend, retain, and implement cognitive strategies due to impaired brain function.

I was staggered by discovering how many aspects of our daily life affect the brain’s ability to process and respond to information. Everything from poor hydration and nutrition to chronic stress and insufficient sleep directly affect how well our brains can recruit and utilize resources to help us focus, analyze, remember, reason, and respond to the world around us. I realized that my understanding of how to help care for minds was severely restricted by my ignorance of the brain and its role in creating emotion, cognition, and social interaction.

While still an intern, I took a position with a private-practice neurotherapy clinic where the primary method of treatment consisted of three parts:

  • Including a recording of client EEG in the intake process,
  • Integrating a quantitative analysis of the activational patterns in the client’s brain into the initial report, and
  • Incorporating a regimen of neurofeedback into a comprehensive treatment regimen achieved in collaboration with other service providers.

By recording brain-wave activity using sensors placed on the head, we could gather information about why an individual could be having clinical symptoms based on what was happening in his or her brain. States of neurophysiological over-arousal or under-arousal can contribute to why a client may be manifesting symptoms of anxiety, depression, obsessive compulsive disorder, attention deficit disorder, and a variety of other stressful conditions. 

Once initial information has been gathered, neurofeedback can be used to track brainwave activity, and train the brain to operate more efficiently by providing visual and aural feedback to clients as their brainwave patterns improve.

It’s Accessible, Affordable, and Can Revitalize Your Practice

Over the years, I have worked to alleviate the symptoms of a wide variety of conditions. The four images below show the kinds of success that are possible with neurofeedback. Each image shows a before-and-after brain map of a client whose recovery I have been privileged to facilitate. 

A growing number of mental health practitioners have been incorporating neurofeedback into their practices. That’s partly because of the increase in availability, accuracy, and affordability of the technology that allows the average therapist to observe and interact with the brain. 

While quality equipment and education is still a necessary part of being a competent neurofeedback provider, the accessibility of hardware, the sophistication of the software, and the growing network of education and support is making this therapy a cutting-edge niche. 

Mental health counselors working to remain competitive during these tough economic times are finding that using neurofeedback can revitalize a struggling practice.

Neurofeedback in Practice: Before and After Images

The following four images contain before-and-after brain maps of clients with whom I have worked. These images are generated by comparing the EEG recording of a client with a normative database of recordings that indicate what the statistically typical brain activation patterns would be for an individual of the same age and sex. 

Areas that are red indicate more activation than usual, while areas that are blue indicate less activation than we would expect to see in those areas when compared to the statistical average. Green indicates activity within a neurotypical range, often associated with more efficient functioning and optimal performance.

1) This image shows the quantitative electroencephalogram (QEEG) brain map of a 7-year-old boy diagnosed with attention deficit disorder who was quite hyperactive and difficult to manage. The map on the left of the image has a number of areas that are red and blue, indicating that his brain was not firing in the ways we would typically expect for a child his age. The way his brain worked made it very difficult for him to concentrate, process and retain auditory information, and respond to instructions. 

The map on the right shows that after 21 neurofeedback sessions, in which his brain was rewarded by visual and auditory feedback when it activated in more optimally functional ways, observable changes in his brain activation took place. These changes corresponded to improvements in his school performance and social behaviors.


2) This image is of a 19-year-old boy with a history of traumatic brain injury, extreme substance abuse, a broken family, and symptoms of anxiety and PTSD. After a suicide attempt and six months of inpatient rehabilitation, we took the first brain map on the far left of the image. The image shows that a lot of areas in his brain were not activating in neurotypical ways. 

He responded extremely well to neurofeedback treatment. After 30 sessions, his EEG was within a more optimal range of activity. He went on to hold down a job for the first time, enrolled in school, and even married a few years after completing treatment. 


3) This image is from a 32-year-old male who crashed his motorcycle into a tree with no helmet on. The blue heads in the top row indicate a brain that is not properly activating, and the client had corresponding difficulties with daily tasks of living, forming new memories, and interacting in socially appropriate ways. 

After approximately 30-40 sessions of neurofeedback, his symptoms were noticeably improved, and the other therapies in which he was engaged were beginning to be more effective as a 

4) The top image shows over-activation of the limbic system in a 55-year-old woman who had struggled since the age of 9 with trichotillomania (pulling out one’s own hair). She had compulsively pulled out her hair and eyebrows and eyelashes for so long that not only was she bald, but she had no memory of what her natural hair color was.  

The red areas in the images on the top indicate 3.2 standard deviations of activity above the norm in her limbic structures, specifically in the cingulate gyrus, an area of the brain that often exhibits dysregulation in individuals with symptoms of OCD. Anything outside of 2.0 standard deviations is considered clinically unignorable. 

After neurofeedback, the activity in her cingulate gyrus reduced to 1.3 standard deviations, well within the typical range, and the hair on her head grew in for the first time since early childhood. She was delighted to discover that she is a redhead.


Penijean Rutter-Gracefire is the clinical consultant and educational coordinator at StressTherapy Solutions, Inc., an international company that provides education and training on neurofeedback for clinicians from a variety of practice backgrounds. For more information, visit www.stresstherapysolutions.com.

American Mental Health Counselors Association

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