Neurofeedback is a type of biofeedback. Biofeedback is a form of treatment that shows you a real-time display of what is going on in your body. For instance, there are forms of biofeedback that show you your heart-rate. What biofeedback does for you is allows you to make subtle changes in your body without exactly knowing how. It’s basically built in reinforcement. You don’t know exactly how it happened, but you made that line move on the screen. Eventually over time, you get more control and are able to manipulate what is going on in your body at will.

Neurofeedback is basically biofeedback that uses some sort of real-time feedback from your brain. In most cases this is in the form of electrical impulses, which is measured by an EEG. They also have some newer versions that operate based off of MRIs which show the metabolism in your brain. The version that your counselor recommended seems to be EEG based. Basically, they place some sensors on your scalp and ears and hook those up to a computer program.

I looked a little bit into neuroptimal. It looks like there are home-based versions as well as a version that you can use with a therapist or provider of some kind. Neuroptimal appears to use an audio cue. It has music that changes and shifts depending on the state of your brain. This is similar to the way the Muse headband works. With the Muse headband, you have an app and it uses music and environmental sounds to help train your brain to be more relaxed.

Neurofeedback may be effective for ADHD, but the research is mixed. There is little downside to trying it out, aside from money. It does not seem to be harmful and in many cases appears to be beneficial.

It is important to determine whether they use a standardized, research-supported protocol. Do some digging before you dive in.

I will say that the research on the neuroptimal site is very impressive, but it’s not peer-reviewed for the most part. It’s basically their own case-studies, which isn’t a rigorous form of research. Doesn’t mean that it wouldn’t work, it’s just important to keep in mind.

So in answering your unasked question of should you try it out or not… it depends. If you are using it for ADHD, there is some research that suggests it would work. If it’s for anxiety or some other issue, there is some evidence that supports it’s use for that reason as well, but again the research is mixed. My best advice would be to look at the research they cite as supporting their product and make sure they are using the same protocol.

Make sure when you are looking at the research that they are measuring the actual construct that you are concerned about. What I mean is that if you are trying to increase states of calm, a subjective measure of how someone feels is going to be able to tell us a lot more information than a certain frequency of brainwaves that are simply associated with calm people.

Hey, I’ve dealt with severe depression since I was younger. It really got bad when I was 16 when I was becoming really insecure about myself then it gradually became a problem with money and working, etc. I’m 26 now and I’ve had a really hard time holding onto jobs due to attendance or feeling like it’s the worst job when in reality not all these jobs have been that bad, for instance my job now. I wake up crying almost every morning and almost every day at work. I currently don’t have insurance to go and see a Dr. I know Doctors and other say exercising is good or finding hobbies to help or even distract yourself or write. Problem is I have no motivation to do any of it or when I say I’m gonna try writing I never know what to write and then I just get frustrated. I still wonder most the time what’s the point of trying and my insecurities about myself break me and it’s jus little things such as when I look in the mirror I see nothing but negative thoughts and I break down. How or what can I do to cope with these things and get the motivation to do those things or to even want to help myself? Thanks

First off, I’m sorry that you’ve been fighting this uphill battle for so long. Depression can be so tricky because it feeds into itself. The lack of motivation makes it difficult to complete tasks that would help you feel better… which makes you feel even shittier when you beat yourself up about it.

I know that you said you don’t have insurance. I wonder if there is any way to get you some treatment, though. If you have a lack of income, there are community clinics and sliding scale therapists that may be able to help. If you have family that is supportive, would it be possible to have someone help you get started in the treatment process?

You have pretty significant symptoms. This isn’t just you being dramatic. It sucks to feel like you do and you’re stuck. You need some sort of nudge to get you unstuck. Therapy and/or medication would be a great, and research-supported way, to make that happen. I shared some tips about low-cost or alternative treatments in episode 125 of the podcast, which you may want to take a quick listen to as well. I think it was the first question that I covered in that episode.

Aside from that, I would encourage you to continue taking in as much helpful and positive content as you can. Podcasts, videos, music, etc. Even if you don’t believe what they are saying or can’t make sense of the lessons that they are trying to give you, just keep pumping it into your brain and something might resonate with you.

With depression, a lot of the stupid suggestions that people give you like diet, exercise, sleep, hobbies, social interaction etc. are actually true. The problem is that it’s not so easy to just say “alright, I’m going to go do all of those things now”.

Paradoxically, finding a way to force yourself to engage and participate in these activities is one of the best ways to build the motivation to actually WANT to do them. This is called behavioral activation.

I have an entire chapter in my book Hardcore Self Help: F**k Depression about it and I also have a blog post that you might find helpful.

Basically, what you are trying to do is force your brain to adapt. You have this well-worn loop right now where you are not really feeling any pleasure or interesting in things. You need to teach your brain to be interested again and to feel pleasure again. The only way to do that is by pretending like you were motivated and going through the motions of whatever you would be doing if that were the case.

One mistake that people make is deciding to try everything at once, which is overwhelming and sets them up to fail… perpetuating that cycle further. Start with one simple change. I say simple, but it could be really hard. Something like waking up at the same time everyday, spending 15 minutes walking around your block 3 times per week, signing up for an Olympic style curling class, or start journaling 3 times per week. Just try to get the ball rolling in any small way. The rest is bonus.

Speaking of journaling, you mentioned that you never know what to write. I have a specific approach that I like to use that has a little more structure to it. If you wanted to go even more structured, you could get something like the 5-minute journal from amazon or many book stores. The 5-minute journal might actually be perfect for your situation.

Overall, I just want to encourage you that there really is so much hope for your situation. You are allowed to be sick and tired of feeling this way, but there are many avenues to improving the way that you feel. It’s obviously not easy, since you’ve been in this situation for quite some time. But it is possible.

It’s just going to take a little movement in any of these areas that we talked about. Just a little wiggle room to start shaking things lose and then more and more pieces will begin falling into place.

Last thing that I will say is that there are so many topics that go along with your concerns that I have already spoken about on the podcast. One thing that you might do is go to my website and use the search bar to look up some key terms like depression, motivation, etc. and browse through the podcast episodes and blog posts that come up.

Anxiety Course Price Drop!

• Head over to KickAnxietyCourse.com to check out the sample lessons from the course
• You can also download my Quick Start Guide that gives you a few of the essential tips from the course that you can start using RIGHT NOW to make a difference for yourself.

When you are ready to make that investment in yourself, use the coupon code PODCAST for a super special discount. (Discount is in addition to price reduction)

Hi there, huge fan of the podcast! I’m a fairly new listener so I apologize if you have covered something similar in the past. I have a question about knowing if therapy is working or not. I have been in therapy for about a year and a half now for anxiety and depression and just started seeing a new therapist about 5 or so months ago. I like her a lot and I feel she is very non judgmental and creates a safe and warm environment. However, I still dread going to therapy every week. I had this problem with my previous therapist as well even though I liked her too and saw her for almost a year, however the feeling of dread never really went away. It’s just so hard for me to open up and talk abut my feelings, I feel very uncomfortable and overwhelmed and usually start crying even when talking about small things. I know that it should get easier the more I do it, but after being in therapy for a decent amount of time and this not changing, I’m wondering if this is really just a matter of getting more comfortable over time or if I need to consider something else like another form of treatment, medication, or just keep trying out new people. I feel like I can’t really improve unless I can be fully open and honest with a therapist, but that feels almost impossible with anyone because I just am so uncomfortable with the whole experience. Thank you and looking forward to hearing new episodes!

This is a really good question. First off, I just want to normalize your experience. You’re not doing something wrong because you feel scared and somewhat uncomfortable in therapy. Huge props to you for continuing to go because you want to make that investment in yourself, even when it feels really difficult. That’s awesome and speaks to your strength.

There are some questions in here that I won’t totally be able to answer without knowing you and having some more information. For instance, there are certainly different types of therapy out there. I’m not sure how similar your two therapists have been, but it could be that a different style of approach would be more tolerable and productive for you. If they are really depth focused and having you go into painful memories and you are more interested in trying to find some solutions for the here and now, someone with a solution-focused style or even cognitive behavioral style might be appropriate. If your emotional reactions are just strong in general, in and out of session, maybe a DBT therapist would be appropriate to help you gain some skills that will allow you to better cope with the strong emotions.

I’ll also say that while 1.5 years of therapy is definitely a decent amount of time, it could be that these patterns, sensitivities, etc. have been building up for many many years and it is legitimately just going to take more time to loosen them up a bit.

You mentioned medication – if you are open to it and have the means to do so, it could definitely be worth seeing a psychiatrist for an evaluation. I have absolutely encountered situations where people are just too burdened by their symptoms to even benefit from therapy and simply bringing those symptoms down to a somewhat more manageable level allows them to better focus on building skills and insights that will endure even if they stop using that medication some day.

If you have some trepidation about medication, just remember that it’s a conversation that you will have with the provider. You won’t be forced into anything. If you need to start small, you can start small. If one medication works, there are tons of other similar medications that might.

If you haven’t already, addressing the feeling of dread and the tearfulness that happens with your therapist could be helpful as well. Trying to understand what about the therapy session makes it that much more difficult than a conversation with a supportive friend may help to reverse engineer a solution.

If there’s an element of you being embarrassed about crying over things that you see as small problems, that is definitely something that could be addressed. I can see  how that would add to your dread. It’s almost like a small scale social anxiety issue where you feel like you are on stage and always embarrass yourself. There are no small problems in therapy. Sometimes the little stuff is the most important. And there is no better place to cry. You will never be judged for doing so. I’m serious. We buy tissue in bulk because it’s supposed to happen.

Again, I just want to encourage you to process this with your therapist. Maybe there is a small tweak that would help things run more smoothly for you without avoiding the important stuff that you need to talk about.

So overall, I think you’re a badass for continuing to push so hard to get better. You have nothing to be embarrassed about. Medication may be helpful if you’re interested in exploring that. And you should talk with your therapist about this very topic to try to come up with a solution together.

Thanks for listening!

Interested in having Duff answer a question on the podcast? Email Duff at robert@duffthepsych.com and maybe you’ll hear it on a future episode!

Want to help out the show and Duff the Psych?

• Subscribe to the podcast on iTunes.
• Leave a podcast review on iTunes. These reviews really help Duff reach potential listeners, and he appreciates every one!
• Share the show on Facebook or Twitter.
• You can also get Duff’s new Kick Anxiety’s Ass Quick-Start Guide for free!