For baseline, clients were asked about the year prior to staring neurofeedback.
Neurofeedback has no predetermined length though most clients get at least 20 sessions. Data reports after 40 sessions will be posted when enough clients reach that point to make the data meaningful.
While the explanations below will say "each client is asked...", in the case of children, reports were taken from their parents.
Reduction in Client Concerns: Prior to starting neurofeedback, each client is asked to identify from five to eight concerns that they can observe and rate on a day-by-day basis. They are given a list of possible concerns in all areas including sleep, attention and learning problems, sensory problems, behavioral problems, emotional problems, physical problems and pain as suggestions.
Once the concerns have been selected, they are asked to rate each concern on a 0 to 10 point scale for a "Bad Week", "Good Week" and a "Usual Week" where lower numbers indicate the concern is less severe. Ratings are made by marking a checkbox on a computer screen or tablet. All previous ratings appear on the screen. The average of the three ratings is the Baseline (BL).
Once neurofeedback begins, the client is asked to make the same ratings at each session. Reduction in symptoms is calculated by averaging the ratings for each concern for the last three sessions.
For the chart on the left, the Average at 10 would be % change in rated concerns for sessions 8, 9 and 10 compared to the BL.
For Average at 20 it would compare the BL with sessions 18, 19 and 20. For the other time periods, the scores would be calculated in a similar fashion.
Self-rating of Coping With Those Stressors: At BL and again after 20, 40 sessions clients were asked to rate on a 1 (not well) to 5 (very well) scale of how well they are coping with the psychosocial stresses in their life.
Taking Medication for Emotions or Pain: Each client was asked at baseline and again after 20 and 40 sessions whether they were taking medication for emotions and/or pain. The graph represents the percentage who reported "yes". at baseline. After 20 and 40 sessions, clients were asked if they were taking medication, or if they had been taking medications, was the medication less, more or the same.
Self-harm/Suicidal ideation: Each client was asked at baseline and again after 20 and 40 sessions whether they had any self-harm and/or suicidal ideation.
Arrests/incarcerations: Each adult client was asked at baseline and again after 20 and 40 sessions whether they had been arrested or incarcerated in the year prior.. One of our sites worked with felons released from prison. However when we added this item to data set, they were forced to suspend face-to-face contact due to Covid so these numbers reflect the fact that they weren't doing neurofeedback.
Disciplinary Actions at School: Parents for each school-aged client was asked at baseline and again after 20 and 40 sessions whether they had disciplinary actions at school. The graph represents the percentage who reported "yes".
Drug or Alcohol Relapses: Each adult client was asked at baseline and again after 20 and 40 sessions whether drug or alcohol use had been a problem and if so, whether they had any relapses.
Nicotine Use: Each adult client was asked at baseline and again after 20 and 40 sessions whether they were using nicotine. None of the agencies had smoking as a focus of treatment. The lack of change may support the validity of answers to other items as a big reduction in reported smoking might have reflected a desirability response.
Medical Marijuana Use: In two of the states medical marijuana is legal. Each adult client was asked at baseline and again after 20 and 40 sessions whether they were using medical marijuana. None of the agencies had this as a focus of treatment. The lack of change may support the validity of answers to other items as a big reduction in reported usage might have reflected a desirability response.
Cognition: QIK test is a computerized visual continuous performance test developed for assessing attention and impulse control. A simple visual target or non-target is presented once every two seconds. During the 21-minute test, the subject must press a button to respond to each target and not press for each non-target. The QIK Performance Index reflects speed and consistency of response, which are continuous variables. The QIK Accuracy Index reflects sustained attention and impulse control, which involve discrete errors. Results are reported at BL, 20 and 40 sessions.
ER Visits for Medical Reasons: Each client was asked at baseline and again after 20 and 40 sessions whether they had a visit to the ER for medical reasons.
ER Visits for Psychiatric Reasons: Each client was asked at baseline and again after 20 and 40 sessions whether they had a visit to the ER for medical reasons.
Hospitalizations for Medical Reasons: Each client was asked at baseline and again after 20 and 40 sessions whether they had a visit to the ER for medical reasons.
Hospitalizations for Psychiatric Reasons: Each client was asked at baseline and again after 20 and 40 sessions whether they had a visit to the ER for psychiatric reasons.
Side-Effects: After 20 and 40 sessions clients were asked if they had had any side-effects from the neurofeedback. The choices were:
None or minimal,
Mild and resolved,
Mild and didn't resolve,
Moderate and resolved,
Moderate and didn't resolve,
Serious and resolved, or
Serious and not resolved.
Client Reviews: Clients are asked to give a narrative review of neurofeedback after 20 and 40 sessions. They could either enter the review themselves or tell the therapist what to write.
Therapy Ratings: Clients are asked to rate the therapy services they may be receiving on a 1 (not very helpful so far) to 5 (very helpful). Neurofeedback is not rated at BL. These ratings allow some assessment of the client's comparative assessment of services.
Age: Seniors = 66+, Adults = 19 to 65, Children ≤18.
Gender: M=Male, F=Female, NB = Non-binary
Adverse Childhood Experiences (ACE''s): Low = ≤3, Medium = 4 to 6, High ≥ 7.
Psychosocial Stressors is based on DSM 5 Psycho-social Stressors: Low = ≤3, Medium = 4 to 6, High ≥ 7. A 10th items, Problems with Health was added to make a 10th item.
Co-occurring Disorders is the clinician's rating of the number of areas the client reports problems (e.g. Depression, Sleep, Pain) Low = ≤3, Medium = 4 to 6, High ≥ 7.
Discontinued, Treatment-Related Clients are clients who terminated either because they didn't like neurofeedback or didn't feel it was helping.
Discontinued, NOT Treatment-Related Clients are clients who terminated for reasons unrelated to the treatment. The majority represented clients who could no longer receive neurofeedback because Covid forced their agency to stop doing face-to-face therapy sessions. If clients returned when the agency opened their neurofeedback services, the clients would not be included in this group.
Treatment Status? are clients of undetermined status. Most are probably from the Discontinued, NOT Treatment-Related Clients group.
No Show and Late Cancellations: While some no shows and late cancellations are unavoidable, high rates of either suggest clients don't highly value the service. In some early trials of neurofeedback in agencies, the no-show rate was dramatically lower with the same clients than for other scheduled events. While the no-show rate by itself is hard to evaluate, it can be very meaningful if a provider already has an estimate of their usual no-show rate.
Premature Terminations: This is the rate of Discontinued, Treatment-Related Clients divided by the number of clients who Finished + Discontinued, Treatment-Related Clients. Like the No Show and Late Cancellation rates, it is difficult to interpret by itself but data from various sources suggests this figure is much lower than many other programs serving similar populations.