Silvia Costales, MFT, BCN


Neurofeedback helps optimize or fine-tune the functioning of the central nervous system. While psychotherapy addresses questions of meaning, relational patterns and skills, and facilitates grief and coping with difficulties–neurofeedback catalyzes the brain’s innate self-balancing capacity. In one person this may result in restoring calm to a nervous system that has become chronically anxious or over-reactive in the aftermath of severe difficulties. In another, it could mean bringing alertness, positivity and a desire to engage with life back to a brain chronically weighed down by depression. For yet another this would mean training the brain to create and sustain more focused attention, alertness, and cognitive performance.

A little history…
In neurofeedback and in neuroscience in general, we are coming to understand the brain or central nervous system (CNS) in a whole new way, very different from the perspective we developed in Psychology in the 20th century.

For roughly 120 years now, psychotherapists like Freud have focused on the question of human suffering largely by developing theories of personality. These theories describe the various ways our personalities are developed and become organized around life’s problems like trauma, grief, and dysfunctional or absent relational environments; and we then meet, or fail to meet, the challenge of maintaining the emotional self-regulation required to have healthy relationships and satisfyingly productive lives.

Then additionally, but especially over the past thirty-five years or so with the explosion of the psychopharmacology industry, we have begun exploring and experimenting with the chemistry of the brain.

In contrast to these two approaches, neurofeedback treatment efficacy is a function of natural brain mechanisms that only recently have come to be better understood. We refer to these healing capacities of the brain by such terms as neuroplasticity, homeostasis, and entrainment. And we understand CNS functioning through a model we call the “arousal model“. These brain dynamics are reflected by and measurable as the electrical activity of the brain, or the EEG.

The arousal model…
The arousal model goes something like this: your CNS or brain works like a brake and gas pedal at the same time. Without good brakes (overaroused), you can’t be calm. Without gas (underaroused), you can’t get going, focus, or sustain attention. There are also patterns of mixed or unstable arousal.

What we have found is that a traumatized brain (whether the trauma occurred through discrete specific events like a car accident, or more subtly throughout development as in chronic emotional abuse or neglect, e.g. a person who grew up with parents who for whatever circumstances were unable to adequately be present, or functional, or responsive) tends to try to compensate. And that compensation comes in the form of overarousal, underarousal, or a mixed pattern of instability. In overarousal, a person feels anxious often, or hypervigilant, and reacts out-of-proportion to stressful events of everyday life. This can really interrupt the functioning of an otherwise bright and capable person!

Depression, ADHD, and other patterns or problems with attention, or some disturbances with sleep, seem to be caused by underarousal, or too much slow wave activity during the day. For instance, spacing out or daydreaming, the kind of thinking we usually do while asleep, may be happening during the day, and the faster brain waves required to organize functioning, prioritize activities, sustain attention, and regulate emotion are lacking. Meanwhile, at night, the brain has difficulty revving down and achieving restful sleep.

These patterns are visible in the EEG or electroencephalogram, a reading of the electrical activity that can be picked up by a simple sensor placed on your scalp. The EEG shows us how much your neurons are firing, in what range, and at what amplitude. And what we’ve discovered is that through neurofeedback we can train our brains to function better, or recover optimal functioning after a setback or derailment.

How neurofeedback works…
Neurofeedback can literally get your brain back in shape. It is entirely non-invasive: nothing is introduced to your system but information, or a reflection of your functioning, and the changes are all made by you. Neurofeedback, is also known as EEG biofeedback, and biofeedback is simply any process whereby you gain greater control over your body by receiving information about it. This can be as simple as using your reflection in a mirror to correct your posture. Your nervous system balances all kinds of processes in your body by feeding back information to itself. Neurofeedback augments this process, giving you a “leg up” in optimal self-regulation.

It’s very much like exercise for your CNS. Your brain, like the heart of a long-distance runner, will be fitter after training. If a runner goes from resting to a sprint down the block, her heart rate will not rise as much and will recover faster than a sedentary person. A sedentary person who suddenly has to run down the block will be totally winded and take several minutes to recover a normal heart rate. Like this, a brain that has been trained by neurofeedback will react with less overall arousal to a stressor, and will recover a sense of normal calm much faster afterwards, maintaining its equilibrium.

Tell me more…

See the resources page for links to more information about neurofeedback online.

“Neurofeedback is a simple, non-invasive approach for increasing affect tolerance, lifting depressive mood states, and calming states of fear from the “bottom up,” by changing brain wave patterns associated with these symptoms.   The best neurofeedback treatment requires both technical competence and precision along with clinical skill and empathic attunement.

Silvia Costales not only offers a warm, validating therapeutic presence but also a very organized, precise approach to neurofeedback responsive to her client’s symptoms week to week.   Well-trained in a wide variety of protocols for different kinds of symptoms, Silvia helps clients to not only find relief but also increase their ability to make use of psychotherapy.”

psychotherapist and author Janina Fisher, PhD

“The more relaxed you are, the better you are at everything: the better you are with your loved ones, the better you are with your enemies, the better you are at your job, the better you are with yourself.”

– Bill Murray

What’s it like…
A course of neurofeedback can take anywhere from 20-400 sessions, because each individual is unique. We will set treatment goals at the outset and re-assess your progress regularly. We start with a 2-hour assessment that includes taking measurements of your EEG at five sites for analysis. Sometimes a more comprehensive assessment is necessary or desirable. This is called qEEG or quantitative electroencephalogram, and requires taking measurements at 19 sites simultaneously. Read more about qEEG here.

After assessment, generally I recommend twice weekly sessions, approx 45-60 minutes each. Once you feel that your important goals have been met we will start to taper (first once a week, then once per month, and so on) until, as long as symptoms don’t return, we are done!

During sessions, sensors on your scalp send a reading to a computer of your EEG. When the signal reflects that your EEG is within an optimal range, computer sounds, or images on a screen will reflect this. What’s neat about this is that it is completely non-invasive. Apart from sticking the sensors to your head, it’s nothing but the audio and visual feedback and your attention to it that has the effect. And most forms of neurofeedback are essentially passive. It doesn’t require effort more than say listening to music.

Without your awareness, your brain is already constantly talking to itself about its functioning, that is to say, feeding-back information to itself. In fact, approximately 70% of the brain’s activity at any given time is feedback. This is how your brain regulates itself, or regulates you. Perhaps this explains why augmenting your brain’s own self-regulatory feedback functions with real-time feedback of cortical oscillations (EEG) from a computer (i.e. neurofeedback) is so helpful to the brain and body.

Because the central nervous system regulates sleep, people often notice the benefits of neurofeedback treatment most immediately through improvements in their sleep.
And when you are done with training, the treatment sticks. Treatment outcomes are known to be robust and lasting. In fact, people commonly report that they continue to make improvements up to year out from treatment because the gains made are generalizing throughout the entire system.

If you are taking medication for anxiety, sleep, attention, or depression, you may find that you need less of it or are feeling over-medicated as your training progresses. Please always work closely with your prescribing physician before altering your use of any medication. Tapering off very gradually is generally the best course.

Getting started…
You may wish to do neurofeedback training by itself, or as an adjunct to your ongoing psychotherapy with another therapist. You might come in to feel more calm overall, to achieve better focus and sustained attention, to get a competitive edge with your professional or athletic performance (a brain that is functioning better can move more gracefully and efficiently), or to attain some other goal.

Neurofeedback treatment begins with a thorough assessment of your present functioning and concerns. Once we determine your goals for treatment we will select a training protocol for you and, with your ongoing input, fine-tune this over the course of your treatment to achieve the best results.

If you are interested in neurofeedback or have more questions about treatment please feel free to call me or use the contact form on this website to get in touch with me.


Psychotherapy & Neurofeedback in Santa Rosa, California | (510) 868-2802