Neurofeedback Informed Consent

A copy of this can also be downloaded here: 

https://docs.google.com/document/d/1xqBaBrycmAsNT38OVQZ-96MD_oduDBoM4BLdXIamq0o/edit?usp=sharing 

Neurofeedback Informed Consent

NEUROFEEDBACK: You have been given the opportunity to receive Neurofeedback, and specifically a type of neurofeedback known as InfraLow Feedback (ILF) Neurofeedback or Othmer Method Neurofeedback and to participate in the Neurofeedback Advocacy Project (NAP). This form of Neurofeedback is a safe, non-invasive exercise that taps into the brain’s own ability to self-regulate. It has been used by many different types of people who seek to maximize their brain’s ability to function, from Olympic athletes (peak performers) to elementary students with ADHD.

HOW IT WORKS:  Like how a doctor uses a stethoscope to listen to your heart beat, sensors pasted to your scalp listen to your brain waves. While you watch Netflix or play a video game, your brain wave activity changes the picture, sounds, and/or vibration. Your brain responds to that feedback and learns to maintain a more stable pattern on its own. No conscious effort is involved. Simply watch the movie or play the video game and your brain will figure out what to do.  

The type of neurofeedback 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 electrodes are placed and what training frequencies are used. Your protocol is based on your history, your specific concerns, assessment data and most importantly, on your response to the training. Your clinician will need to ask questions about physical and emotional symptoms and history to know which locations to train and when to add or subtract a location. The clinician 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 obviously no specific results are guaranteed.

SET YOUR OWN GOALS AND TRACK YOUR PROGRESS:  An important part of Neurofeedback is that you determine your own goals. Typical goals include reductions in: anxiety, or pain, and improvements in: sleep, focus, or mood. Improvements are usually durable 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 around  5 symptoms or concerns you hope will improve with treatment. These should be concerns you can easily observe in yourself 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 will be asked about events in your life. Most answers are either yes/no or a rating scale. Also, you may be asked to take the QIK test, a computerized test of thinking speed and accuracy using a handheld device. It is best described as “the world’s worst video game”. This test is also repeated after every 20 sessions. 

SHARE WHAT YOU OBSERVE OR FEEL WITH YOUR CLINICIAN:  It is very important to report any and all changes, either in the session, or between sessions, good or bad, even if they seem unrelated to the Neurofeedback. After numerous studies spanning decades, there is no evidence that this form of Neurofeedback has ever caused any unwanted, serious, long-lasting effects. However, you can experience short term negative effects such as a headache, worsened sleep or low energy. When you tell your clinician of this, they  can make the appropriate adjustments. These issues typically resolve quickly after the feedback software settings are adjusted. For a child or person with limited ability to report effects, parents and caregivers are expected to observe and report observations to the clinician. 

MEDICATIONS: It is important to notify your clinician of all medications and supplements you are taking, as well as any changes.  Because Neurofeedback helps the brain work better, medications may need to be adjusted. Never stop or change dosing of any medications without your prescribing doctor’s supervision. 

OTHER FACTORS WHICH AFFECT NEUROFEEDBACK:  Notify your clinician of any and all other changes in your life which may affect mood or performance, such as changes in medications, 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 is interfering 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.  However, many people find that Neurofeedback makes it easier to  stick to decisions when they have a better functioning brain.

LENGTH OF TREATMENT AND PERMANENCE OF IMPROVEMENT: For many diagnoses (ADD without hyperactivity, anxiety disorders, simple depression, and common sleep problems) treatment typically requires 20 sessions, although improvement are usually noticed after 2 or 3 sessions. Effectiveness will be re-evaluated after 20 sessions and more sessions may be made available as needed and determined by the clinician. Sometimes more severe issues require more sessions or some “booster sessions” may be advised to maintain positive improvements gained. These types of sessions would be arranged in consultation with the clinician.

SCHEDULING OF SESSIONS: The Neurofeedback portion of a therapy session is 30 minutes long with an additional 15 minutes for collecting a report, set-up, and clean up. An optimal schedule for Neurofeedback treatment is twice weekly for 10 weeks if schedules permit, or at least weekly for best results.

DATA COLLECTION: Your clinician and their agency is participating in the Neurofeedback Advocacy Project (NAP). The goal of the NAP is to collect data on the effectiveness of neurofeedback in different settings and with different clinical populations. Your personal measures will be combined anonymously with data from others receiving Neurofeedback as part of our Neurofeedback Advocacy Project. Your data will be identified with a coded number, not your name or other information that would identify you.   All of this data is collected in the Results Tracking System (RTS). It is an online, HIPAA compliant system. You can learn more about the project from the website neurofeedbackadvocacyproject.com If your therapist also has you complete other questionnaires that are used to evaluate your progress, that data may also be shared with the Neurofeedback Advocacy Project. This information will not contain any identifying information so your responses will be completely anonymous. 

YOUR clinician WILL PARTICIPATE IN AN ONLINE CASE DISCUSSION GROUP: Your clinician and the 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, gender/gender identity, coded number. The purpose of these discussions is to learn the best ways to use Neurofeedback for your benefit and for team learning.

I understand these potential benefits and risks of Neurofeedback training.      

I will report all changes I notice so the clinician can make appropriate adjustments.   

By giving consent you are also agreeing that your questions have been answered and you understand and agree to participate in Neurofeedback treatment. You give permission for data about outcomes of your treatment to be collected and understand that all information will be anonymous as to the name of individual participants. 

I agree to participate in Neurofeedback training under these conditions.        

Signature: _____________________________________________ Date: ________________

Name (Print) ___________________________________    

Parent Name: __________________________________

Guardian Name: ________________________________