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Case Study of a Counselling Client Using Biofeedback and Neurofeedback

Dr Patricia Sherwood, Frank Kroll

Sophia College, Bunbury, Western Australia


Dr Patricia Sherwood

Sophia College,


Western Australia 6231



Frank Kroll

Gwelup Counselling


Western Australia 6018


Frank Kroll has qualifications in engineering, town planning, counselling, and brain training.  He is a graduate of Sophia College and has an Advanced Diploma of Holistic Counselling and Diploma of Mindfulness.  He also has an Advanced Certification in Zengar NeurOptimal®.  He is the Director of Gwelup Counselling and together with his wife provides counselling and brain training services to adults, adolescents and children.  Their aim is not only mental health but also work, school and play performance.  He is interested in psychological and spiritual research for the betterment of individuals, families and societies.

Dr Patricia Sherwood is a post-graduate supervisor at Notre Dame University specialising in phenomenologically based research particularly in the field of counselling, artistic therapies and complementary health therapies. She is also director of Sophia College where she designs and teaches courses in holistic counselling, Buddhist psychotherapy and artistic therapies. She has published widely in the fields of community development, holistic education and artistic therapies in counselling. Her most recent psychological publication is CBT & Artistic Therapies describing the commonality between cognitive and energetic models.



This paper provides a comprehensive case study over 12 sessions of a young 13-year old female adolescent client with no diagnosed mental health problems, but who showed stress related symptoms and learning difficulties.  It was conducted over 4 months using a combination of short verbal counselling, Zengar NeurOptimal NO3® neurofeedback, and the low cost HeartMath emWave Pro® biofeedback device.


The first 6 sessions of the study used biofeedback before neurofeedback, and the last 6 added biofeedback afterwards.  Experiential ratings were conducted at the beginning, middle and end of the study.  Coherence showed improvement, and by the end of the study the experiential rating showed an improvement of 30% across all symptoms including sleep, mood and learning ability.

It is concluded that the biofeedback product emWave® is useful to clients at selected times in the counselling process and can be used together with neurofeedback to impprove mental states. 

Keywords: biofeedback, neurofeedback, nervous system, stress, self‐regulation, heart rate variability.

Subject classification codes: Class 8599


This study was conducted by counselling practitioners to explore the use of technologies with counselling with respect to stress management.  It was initially assumed that counselling would improve coherence, a brain state of synchrony, harmony and peace, thereby reducing stress.  After some initial testing, it was found that counselling, due to its approach in exploring previous and current trauma and psychological difficulties, may decrease coherence in the short term after counselling.  The process is not necessarily calming, unless the session is designed that way.  From the literature review, specific coherence enhancement approaches may be more appropriately done after a number of counselling sessions, and use of biofeedback and neurofeedback devices can achieve those objectives more effectively and in a shorter time.  It was on this basis that emWave® biofeedback was coupled with NeurOptimal® neurofeedback. Theoretically, by linking brief counselling which gives context, together with biofeedback and neurofeedback, the client will progress faster in achieving improved mental and emotional functioning in a short timeframe, and have tools to self-help into the future. Kroll has been using NeurOptimal® training for 6 years, and emWave Pro® for 1 year. Sherwood has also used the emWave® for 1 year.  The Pro version allows trainers more assessment ability, but the less expensive emWave® base model is sufficient for client training.


Combining the two modalities has been trialled previously.  An independent study was conducted by Dutt, Reid-Chung, Thompson, Thompson and Lee (2016) of a single client attending two sessions per week of biofeedback combined with neurofeedback. Biofeedback was practiced for about 10 minutes at the beginning of each session to master breathing at approximately six breaths per minute, to try to achieve synchrony between breathing and heart rate.  The study was done over a 40-week period, and illustrates amelioration of cognitive, motor, social, and sleep-based symptoms.  This suggests neurofeedback and biofeedback have a positive role to play in helping people with agenesis of the corpus callosum displaying cognitive, motor, and social difficulties (Dutt et al, 2016).


Biofeedback can be described as an electronic monitoring and real time display of a normally automatic bodily functions and also training for the client to voluntarily control that function (Oxford Dictionary, 2019).  In this case, the heart beat is monitored to assess Heart Rate Variability (HRV) as a measure of coherence, and training includes instructions on breath, and emotions such as appreciation, compassion and care (HeartMath, 2015). In this way physical, mental, emotional and spiritual health is improved. Much like physical therapy, biofeedback training requires active participation on the part of the client and often regular practice between clinical training sessions. Clinical biofeedback may be used to manage disease symptoms as well as to improve overall health and wellness through stress management training. Research has shown that biofeedback interventions are efficacious in treating a variety of medical conditions. (NCBI, 2010).  The emWave® was used as both a training and a monitoring device to collect data.


Neurofeedback is then provided following biofeedback.  It is also an electronic monitoring and real-time display specifically of the brain and nervous system activity.  In the case of traditional neurofeedback, the client is trained to learn to control that activity.  Neurofeedback is a form of biofeedback, which teaches self-control of brain functions to subjects by measuring brain activity and providing a feedback signal, that can be audio or visual (Wikipedia, 2019). Clinical applications of neurofeedback are treatment of attention deficit hyperactivity disorder, anxiety, depression, epilepsy, insomnia, drug addiction, schizophrenia, learning disabilities, dyslexia and dyscalculia, autistic spectrum disorders and so on as well as other applications such as pain management, and the improvement of musical and athletic performance. Many studies have been conducted on the neurofeedback therapy and its effectiveness on the treatment of many diseases. Neurofeedback, like other treatments, has its own pros and cons. Nevertheless, neurofeedback is known as a complementary and alternative treatment of many brain dysfunctions. (NCBI, 2016). In the case of NeurOptimal® audio feedback is provided on 20 frequencies simultaneously and no effort is required of the client.  They may even fall asleep.


An independent study described NeurOptimal® being designed to interface with the nervous system as a non-linear complex dynamical system, whereas traditional 'evidence based' research tends to measure linearly.  In that study, it measured individual outcomes because that's what clients and referral sources really want to know. NeurOptimal® is training at the source of complaints, namely the fluttering of the nervous system, rather than treating diagnostic comments. It looks at outcomes across diagnostic categories rather than trying to compare medically defined groups where fallible diagnostic judgments may create more issues. The study showed the efficacy of 62 clients trained.  Range of improvement efficacy ranged between 55% and 91% of all clients trained. Number of sessions per client ranged from 7 to more than 21.  More training results in greater efficacy (Cross, 2013).  In our study experiential rating data was gathered using a progress tracking tool of several categories of physical, emotional, and mental concerns.



Body of Study and References not provided online.




This study concerned the efficacy of biofeedback and neurofeedback in improving client health and performance.  In this study improvement was rated at 30% after 12 weeks of training, despite an increase in challenges.  There has been sufficient improvement of the initial concerns, that now training frequency has been decreased to monthly. The use of biofeedback and neurofeedback has accelerated Cleo’s improvement across several measures.  This study has demonstrated that with the current technologies available through the power of computing, effects can be seen in real time, and also be effective in a much shorter time.  Sometimes weeks instead of months or years.  This then becomes much more useful within the therapeutic context, as biofeedback and/or neurofeedback can intertwine with selective counselling for maximal outcomes.  It also helps the client to understand themselves experientially, with respect to their own breath, emotion, thought processes and how to quieten them. 


It is concluded that the biofeedback product emWave® is useful adjunct to clients presenting to counsellors at selected times in the therapeutic process for training and measurement.  It can be used together with other technologies, such as NeurOptimal® neurofeedback to facilitate client self-empowerment in relation to their mental states.  Additionally, emWave® can be taught to clients as an adjunct to counselling geared towards coherence training, as a low-cost self-empowerment method of improving and sustaining their positive mental health. It engages elements of both the body and mind.  Both products can be purchased by clients, and used on their own if trained.  The emWave® is very low cost, but some education and dedication are required to achieve the best outcome.  The upside is increased self-knowledge.































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