This presentation reviews the historical development of symptom guided neurofeedback (NFB) and EEG / QEEG based NFB, and their more recent synthesis in clinical practice. In the late 1960s, Professor Barry Sterman founded the field of NFB with his discovery that NFB can control seizure disorders. From that point on, practitioners began using NFB to treat a wide variety of disorders, mostly tracking changes in symptoms to guide NFB. At the same time, university based research continued to correlate EEG patterns with symptoms. With the rise of Quantitative EEG analysis in the 1980s, it was proposed to use deviations from normative data to guide NFB. Both voltage based norms and coherence based norms were developed. Thus two schools of thought developed, and a certain rivalry emerged between the two.
More recently, a synthesis of the two systems has occurred: Clinicians are increasingly looking at EEG to help guide NFB, while EEG and QEEG experts are recognising that a blind application of normative deviation as the driver of NFB protocols lacks clinical sophistication – understanding symptomatology is critical. The classification of EEG into phenotypes, or failure modes, by Jay Gunkelman and Jack Johnstone has given a useful framework from which one can analyse EEG, in reference to symptoms, and maximise the effective application of NFB. This is explained, with case examples. The strengths and limitations of this methodology are discussed.