This article tracks the evolution of the practice of neurofeedback over the past quarter century from the perspective of services offered at a private clinic. It describes why and how the authors changed their practices from interventions including medication, psychotherapy, and tutoring to biofeedback interventions. Their evolving practices required complex assessments including single- and two-channel quantitative electroencephalograph (QEEG) and later 19-channel QEEG combined with evoked potentials, heart rate variability, continuous performance testing, and neuropsychological assessment. The article stresses that interventions require a multimodal approach. The neuroanatomical rationale for combining neurofeedback and heart rate variability (HRV) training is provided as well as a discussion of how a systems theory of neural synergy helps explain how neurofeedback influences brain networks. Assessment procedures are described in some detail because that information is used to develop effective interventions that typically combine neurofeedback (single-channel or LORETA Z-score neurofeedback, as indicated) with HRV training. The authors stress using evidence-based approaches, basing intervention on assessment, and keeping current with new developments in applied neuroscience.

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