Photo by Helena Lopes from Pexels

Infra-low frequency neurofeedback

"Neurofeedback in its most advanced form". K.Segler

Several methods of neurofeedback (NFB) using different technologies are available nowadays. They include recording electroencephalography (EEG) signals, functional magnetic resonance imaging (fMRI), functional near-infrared spectroscopy (fNIRS), magnetoencephalography (MEG), and infra-low frequency training (ILF).
Infra-low frequency training is the latest generation of neurofeedback, which refers to training brain rhythmic activity that lies below 0.1 Hz (it means less than one wave every 10 seconds). Standard neurofeedback frequency for treating ADHD in children is much higher: 4-8 Hz (theta range), 12-15 Hz (sensorimotor rhythm), 16-20 Hz (beta range), but the full band EEG contains long-lasting potential shifts that are assigned to slow activities of the frequency range below 0,1 Hz.

By Schneider H. et al (2021), ILF utilizes both, the brain activity of conventional frequencies in the human EEG (1-40 Hz) as well as activities in the frequency range of slow cortical potentials below 0,1 Hz. Other characteristics of the ILF neurofeedback protocol include a bipolar montage of the electrodes, placement of the electrodes on the skull according to individual criteria of the patient's arousal level and mental strength, and continuous feedback of the parameters extracted from the full-band EEG in audio-visual computer animations that have a game-like character.

Picture by Othmer S. et al., 2016

Electrodes are situated at the P4 and T3, T4 sites according to a 10-20 system (it is the usual starting point of ILF neurofeedback protocols with minimal risk of side effects).
The tonic slow cortical potential appears to be a direct reflection of the dynamics of cortical excitability. With a signal derived from bipolar montage, network relations are revealed, and thus the training impinges directly on dynamic functional connectivity, in addition to calming hyper-excitability directly. By operating in the ILF regime, the training preferentially accesses the functional connectivity of the intrinsic connectivity networks that were originally identified in fMRI [Grin-Yatsenko V., 2020].

ILF training also impinges on the autonomic nervous system regulation (ultradian cyclic fluctuation of physiological arousal), and thus improves the emotional equilibrium of patients, which in turn positively influences attention and memory. Othmer S. (2016) provided further evidence with respect to vigilance and attention was recently documented in a large-scale compilation of pre- and post-training continuous performance test data on a clinical population. Clinically significant improvement in performance was consistently observed among those in deficit.

The major difference between standard neurofeedback training and ILF is that patients are no longer given an active task to intentionally self-regulate. ILF training can't work through an operant conditioning model since there are no discrete events to reward. There is a complex multifrequency band algorithm of inhibits that follows the individual subject's regular pattern of EEG activity using thresholds that reset moment-to-moment to allow for approximately 95% success rate (which can be modulated in the software) of the signal remaining below the threshold. Thus, patients just play computer games. The computer program processes information from the EEG onto the screen by way of tones and images (tactile feedback is possible). Too subtle changes give feedback: it may be a modification of volume, brightness, color, speed on the screen. The patient can do nothing during the ILF training session. ILF training process correlates with the fluctuation of oxygenated and deoxygenated blood in the brain, regulates all the classic brainwave bands (i.e., alpha, theta, delta, beta, gamma). The brain regulates itself.

Why do patients show such powerful effects on the slow-changing signals in
ILF training? It was revealed that those low potentials influence the brain at the level of neural networks— that is, the interaction of different areas of the brain. Networks dedicated to self-regulation of internal arousal and excitability are the most important link in this process, and the interaction of the three networks affects the ability to concentrate.

ILF training can yield surprisingly substantial improvements in a variety of clinical conditions in a reasonable number of sessions, 20-40. Some reports argue that the rapidity with which results are sometimes achieved is excellent. ILF training induces persistent changes in the amplitude distribution within the ILF spectral range.

ILF neurofeedback is a particularly effective treatment method for the brain's dysregulated pathologies. ILF training leads to clear and sustainable positive changes in ADHD and autism, depression, different forms of anxiety and sleep disturbances (including insomnia), migraines, addictive disorders, post-traumatic stress symptoms, irritability, bipolar disorders.

Side effects are not common. Mild fatigue, headache, dizziness can appear rarely.


1) "We conducted this multi-center study to address the question of whether ILF neurofeedback is an effective and significant treatment for ADHD and leads to an improvement in quality of life of those affected.

A total of 251 ADHD child and adolescent patients were included in this study and received a treatment consisting of an average of 39 ILF neurofeedback sessions over a period of at least 15 weeks (about two sessions of neurofeedback per week). Only three patients decided to discontinue treatment prematurely. Although we did not investigate this aspect scientifically, it can be concluded from the low dropout rate that the ILF neurofeedback was well accepted as a treatment method by the vast majority of ADHD patients (and their parents). According to the patients' self-disclosure or evaluation by the therapists, 97% of the patients reported an improvement of the symptoms which had been individually perceived as stressful before the neurofeedback therapy. Only 3% of the patients claimed no noticeable improvement of the symptoms by the ILF neurofeedback training. The general effect of the ILF neurofeedback treatment therefore can be rated as excellent.
In order to make the patients' subjective assessment of their symptoms measurable, they were asked before and after the end of treatment to perform an evaluation of their most prominent symptoms on the basis of severity levels between 0 and 10. The most severe symptoms were chosen from a questionnaire of 137 ADHD-specific and other symptoms. This included the categories sleep, attention and learning behavior, sensory and perception, behavior, emotions, physical symptoms, and pain. Regarding symptom tracking, complete data sets were unfortunately only available from 43 patients (and thus only from about 1/6 of the participating children and adolescents). Nevertheless, the size of this sample is sufficient for a statistical analysis in which we focused on the three core symptoms of the ADH disorder, inattention, hyperactivity, and impulsivity. Before the ILF neurofeedback intervention, the severity of inattention was rated to be at 8.3 on average and thus, experienced as to be very pronounced. A similar average severity level was reported by the participants for the symptom of hyperactivity, which was 8.1. The impulsivity was rated at 7.4 on average and thus, only slightly less severe than the before mentioned symptoms. This shows that the three core symptoms of ADH disorder are indeed perceived by the patients as highly burdening. After the therapy of approx. 30 sessions of ILF neurofeedback, the patients assessed these symptoms as significantly less stressful, with a clear average improvement in inattention by 1.9 severity points and in hyperactivity by as much as 3.5 severity points. Regarding the severity of their impulsivity, the participating children and adolescents rated a slight but significant decrease of 1.3 severity points after the treatment. From these results, it can be concluded that 30 sessions of ILF neurofeedback, according to the subjective perception of the patients, are sufficient to improve hyperactivity and inattention symptoms in children and adolescents with ADHD. The treatment can also lead to a slightly milder, but still significant improvement in impulsivity in the same group of patients. These effects of ILF neurofeedback therapy are in accordance with the results of controlled studies on ADHD using other neurofeedback protocols.

These positive results are mainly based on the subjective sensations and experiences of ADHD patients. In order to examine and monitor the quality and effectiveness of the ILF neurofeedback treatment on the basis of more objective criteria, the participants completed a 21-minute visual GO/NOGO continuous performance test (CPT) before the start and after the end of the intervention. Through this measure, the parameters of attention and impulse control could be directly examined in detail. The three attention parameters that were tested are the response time, the variability of the response time, and omission errors. The reaction or response time (RT) is the mean of all correct reaction times to a target stimulus ("GO" condition) and is a measure of the speed of responses. This attention parameter is accompanied by the variability of the response time (VAR), which is a measure of the consistency of the response. Finally, omission errors occur when the subject does not respond correctly to a target stimulus, which is assessed as a sign of inattention. A comparison of the test results prior and after about 15 weeks of ILF neurofeedback intervention revealed a significant improvement of all three attention parameters. The average Reaction time decreased by 21 ms, VAR for 18 ms and the averaged OM by −4.6 errors.
Commission errors (CO) in the CP test occur when the patient responds (incorrectly) to a non-target ("NOGO") task, which makes this test parameter a good measure for impulsivity. In all participating patients, impulse control improved significantly from an average of 19.1 CO errors before the ILF neurofeedback treatment to only 9.0 CO errors after the intervention.
All objective improvements in the attention and impulsivity parameters examined in the CP testing are completely consistent with the ADHD patients' subjectively perceived reductions in the severity of their symptoms of inattention, hyperactivity, and impulsivity, which were rated as highly distressing prior to ILF neurofeedback treatment. Based on the data and feedback from clinicians and patients it, therefore, can be concluded that ILF neurofeedback can be seen as an effective method to treat ADHD in children and adolescents".

Schneider H., Riederle J., Seuss S. (2021) Therapeutic effect of infra-low frequency neurofeedback training on children and adolescents with ADHD. In (Ed.), Brain-Computer Interface [Working Title]. IntechOpen.

2) "After completion of 20 training sessions, all nine participants of the ILF NF group indicated improvement in their health status. Most of them reported a decrease of reactivity to stressful factors and release of inner tension, improved body, and spatial awareness, and mood stability. Also, they noticed an increase in energy level and better cognitive performance.
The post-training EEG patterns in all 9 members of the ILF NF group revealed a significant enhancement of spectral power in the 0.01-0.5Hz frequency band compared to the pretraining EEG. One-way ANOVA detected a significant main effect of the factor "Condition" for the slow activity in the 0.01-0.5Hz frequency band for the ILF NF group"
Grin-Yatsenko V., Kara O., Evdokimov S. A., Gregory M., Othmer S., Kropotov J. D. (2020). Infra-low frequency neurofeedback modulates infra-slow oscillations of brain potentials: a controlled study.

Journal of Biomedical Engineering and Research, 4, 1-11.
Infra-Low-Frequency.pdf (

3) "This study aims to describe the processes underlying implicit electroencephalographic neurofeedback. Fifty-two healthy volunteers were randomly assigned to a single session of infra-low frequency neurofeedback or sham neurofeedback, with electrodes over the right middle temporal gyrus and the right inferior parietal lobule.
Observed increase in connectivity between the salience, language, and visual networks after infra-low frequency neurofeedback from the T4P4 site may represent a beneficial effect of potential clinical value.
A single session of implicit infra-low frequency electroencephalographic neurofeedback leads to significant changes in intrinsic brain connectivity"

Dobrushina O.R., Vlasova R.M., Rumshiskaya A.D., Litvinova L.D., Mershina E.A., Sinitsyn V.E., Pechenkova E.V. (2020) Modulation of Intrinsic Brain Connectivity by Implicit Electroencephalographic Neurofeedback. Front Hum Neurosci. 23;14:192. doi: 10.3389/fnhum.2020.00192.
Sci-Hub | Modulation of Intrinsic Brain Connectivity by Implicit Electroencephalographic Neurofeedback. Frontiers in Human Neuroscience, 14 | 10.3389/fnhum.2020.00192

4) "In the present survey, substantial functional improvement has been documented across the entire clinical population served by ILF neurofeedback by the whole clinician network over the time span of a decade. We have focused on CPT (Continuous Performance Test) data that are computers cored, and thus not dependent on interpretive judgment by either client or clinician.
With neurofeedback in general, but with ILF neurofeedback in particular, we have observed a predominance of whole-brain impacts, with functional improvements observed in parallel across various functional domains"

Othmer S. (2018) Evidentiary Basis for Infra-Low Frequency Neurofeedback. The EEG Institute, California, USA
Evidentiary-Basis-for-ILF-Neurofeedback.pdf (

5) "Infra-low frequency training is an emerging approach to neurofeedback that is
intrinsically function-oriented, as opposed to targeting dysfunction. The clinical results cannot be explained on the basis of a placebo model; hence the results stand on their own, even absent validation via a placebo-controlled design. The method cannot be described in terms of the standard operant conditioning model; nor does the method rely on conscious mediation. Instead, the results are explained in terms of conventional skill learning.
In its essence, the training must be understood in the optimum functioning frame, as
these results are achieved without explicit guidance or micro-management by the
clinician. The clinician's role is one of discerning which 'window into brain function' is most salient for the brain's burden of enhancing its own functional competence.
By working at extremely low frequencies with a right-hemisphere bias, the method
addresses the foundations of our regulatory hierarchy, thus opening the door to the
therapeutic relief of conditions traceable to early childhood developmental deficits or
misdirections. As such, ILF training has allowed us to address challenging clinical
presentations that did not yield to our earlier, higher-frequency protocols. In this work, there is a complete continuum between working with a clinical population and one concerned entirely with optimal functioning"

Othmer S., Othmer S. (2016) Infra-low frequency neurofeedback for optimum performance. Biofeedback 44: 81-89.
Infra-Low-Frequency-Neurofeedback-for-Optimum-Performance.pdf (

6) "The immediate objective in these methods is to train the autonomic nervous system toward better regulation, and this has beneficial fallout for emotional regulation and arousal regulation as well. That in turn, has positive implications for pain syndromes, the anxiety-depression spectrum, and sleep disregulation in particular"

Othmer S. A rationale and model for infra-low frequency neurofeedback training. The EEG Institute, 6400 Canoga Ave, #210, Woodland Hills, CA 91367
A Rationale for Infra-Low Frequency Neurofeedback Training (

7) "The particular strength of the infra-low frequency training is in application to the various trauma syndromes that afflict core state regulation, which must be the clinical priority. This includes in particular developmental trauma and the autism spectrum, where systematic remedies have clearly been lacking. It also includes the adult manifestations of early trauma such as Dissociative Identity Disorder, Borderline Personality Disorder, other personality disorders, and chronic pain syndromes. A case series for pediatric epilepsy utilizing ILF training has been published.

The largest documented experience base exists for PTSD among recent combat veterans.32 In a survey of some 300 trainees in the 2009-11 timeframe, about 25% recovered within twenty training sessions. Another 50% recovered within 40 sessions. The remaining 25% either took even longer or recovered only partially. Recovery meant that symptom severity fell below clinical significance. Some 75 symptoms of dysregulation were tracked. 90% reported recovery from migraines. In 80% of those suffering from depression, scores were cut in half within two weeks, or less than ten sessions. The same was found for anxiety. There was nominally 75% response for most symptom categories. The least responsive symptom was tinnitus, at 50%. These results were presented at a professional meeting but have not been published"

Othmer S., Othmer S. (2013) The Growing Role of Neurofeedback in Integrative Medicine.
(PDF) The Growing Role of Neurofeedback in Integrative Medicine | Siegfried Othmer -


1) Schneider H., Riederle J., Seuss S. (2021) Therapeutic effect of infra-low frequency neurofeedback training on children and adolescents with ADHD. In (Ed.), Brain-Computer Interface [Working Title].

2) Markovics J. (2021). Training the Conductor of the Brainwave Symphony: In Search of a Common Mechanism of Action for All Methods of Neurofeedback. In D. V. Asadpour (ed.), Brain-Computer Interface [Working Title].

3) Grin-Yatsenko Vera. (2020) Infra-Low Frequency Neuro Feedback Modulates Infra-Slow Oscillations of Brain Potentials: A Controlled Study. J Biomed Eng 4: 1-11.

4) Segler K. (2021) The development of the Othmer method. Original text in German: "Die Entwicklung der Othmer-Methode - Neurofeedback in seiner modernsten Form".

5) Papo D. (2018). Neurofeedback: principles, appraisal and outstanding issues. European Journal of Neuroscience. doi:10.1111/ejn.14312.

6) Grin-Yatsenko Vera et al. (2018). Effect of Infra-Low Frequency Neurofeedback on Infra-Slow EEG Fluctuations. Biofeedback, edited by Mark Schwartz, IntechOpen, 2018. 10.5772/intechopen.77154.

7) Othmer S., Othmer S. (2016) Infra-low frequency neurofeedback for optimum performance. Biofeedback 44: 81-89.

8) Micoulaud-Franchi J.-A., McGonigal A., Lopez R., Daudet C., Kotwas I., Bartolomei F. (2015). Electroencephalographic neurofeedback: Level of evidence in mental and brain disorders and suggestions for good clinical practice. Neurophysiologie Clinique/Clinical Neurophysiology, 45(6), 423–433. doi:10.1016/j.neucli.2015.10.077.

9) Othmer S. A rationale and model for infra-low frequency neurofeedback training. The EEG Institute, 6400 Canoga Ave, #210, Woodland Hills, CA 91367
Made on