Synergy Between Neurofeedback and Biofeedback Enhances Therapeutic Outcomes.

This paper discusses both the 'why' and the 'how' concerning a multi-modal approach to enhancing treatment outcomes with a variety of clients. First, the necessity of an approach to client care that combines treatment modalities will be discussed. Then comes discussion of the history of combining modalities along with discussion of which combinations of treatments should be considered for different disorders. Attention-Deficit/Hyperactivity Disorder (ADHD), for example, requires more than one intervention because its neurological basis means it is appropriate for the brain-based intervention of neurofeedback and its comorbidities require other interventions, such as biofeedback for improved emotional regulation if there is anxiety and/or depression, and coaching in learning strategies (metacognition) to help with academic delays and/or learning disabilities. The triad of neurofeedback, biofeedback (especially heart rate variability training) and metacognitive strategies will produce improvements in most clients, regardless of their disorder. Additionally, it can also be used with athletes and executives to optimize performance. For complex cases, further interventions can be added. Medication might be needed as part of multi-modal management in ADHD or in depression or a seizure disorder. The dose can be tapered and, usually, eliminated, once the neurofeedback training produces a reduction in symptoms. Strategies can cover a wide range of approaches that are based on clients' needs and presenting problems; for example, psychotherapy to deal with emotional issues. The final section of the paper shares clinical examples of how treatments can be combined and mentions adding newer interventions, as appropriate, including listening therapy, transcranial direct current stimulation (tDCS) and photobiomodulation (PBM).