Andrew Hill on Neurofeedback: A Revolutionary Approach to Mental Health Treatment

okay Dr Andrew Hill welcome to the podcast hey thanks for having me mark thank you so I'm I'm like we were just talking about it I'm very interested to hear about what you're working on with h neuro feedback so yeah please tell us more about what neuro feedback and and brain mapping what these things are sure so um brain training or neuro feedback is a form of Bio feedback and we essentially measure the brain in real time and when the brain briefly shifts in the right direction we applaud that with auditory and visual feedback so it's a form of operant conditioning where you sort of watch what's happening in terms of like behavior in this case behavior is involuntary it's brain waves and uh you can sort of create this change in the brain over time progressively using uh neuro feedback we start with this thing called brain mapping or quantitative EEG which is an assessment of the resting patterns one person's brain makes compared to an average population and it's a little hard to interpret one person's brain because people are kind of weird so we're using this population comparison but the goal is not to say you know why aren't you average it's to look for things that are sticking out that might help you understand um resources and the stuff we can see in a brain map would include things like attention anxiety flavors sleep architecture or or the consequences for not having good sleep more accurately sensory and social irritability um and things like brain fog and speed of processing so big gross resources what we can pick up in a brain map we also do um performance testing so I always combine a qeg or the brain recording with continuous performance testing or a go noo style attention test and both of these things both the brain and the performance are compared to age match samples so we see how weird you are compared to folks your age and uh out of that we often develop um sort of workout plans to go after the brain waves and people train their brain for about three or four times a week or half an hour at a time and you start to feel it in about three or four sessions and then you get an after effect each time and you can sort of uh think of neuro feedback like personal training for the brain where you have this you know the these goals you're going after you exercise the brain for a little bit and then you have an after effect for the next day and you can kind of grade your workout based on how it landed and how your sleep and stressed and things are moving so well it's um it's really interesting uh I I did years ago I was a subject in um I got to try out a some kind of a neuro feedback system and I remember this is probably going back 30 years and and they they hooked us all up to um EEG leads on our our heads and and we were hooked up to like a a PC with some software and I and I think it was uh there was audio feedback I think that we our Target our goal was to get the a tone that we heard in the headphones to uh to a certain or get it to go down and pitch or something like that and at one point there was actually a video game they let us play around with where you get these balloons to to go into a um a bucket or an area in the middle of the screen you actually control the video game with your brain so you just look at it and focus and you could actually control what's on the screen interesting most neuro feedback is actually involuntary what your describing sounds like something called slow cortical potential where you can concentrate and change uh things in real time the vast majority of neur feedback is involuntary because uh you can't feel your brain waves and you can't really control them uh all that voluntarily in fact neuro feedback was discovered um pushing 60 years like 57 years ago now on cats and cats are really bad instruction followers right so it's sort of this involuntary training and I've done tons of work on people that are non-verbal people that have uh no language people that have uh impaired cognition and it works regardless of what's going on with your brain to some extent it's not not really a a participatory process but you get to sort of pick goals and then creade the after effect so that's sort of the voluntary piece from our perspective is uh deciding what you're working on and moving through making some change you know I I didn't describe what it actually is maybe I should back up and um describe the technique because people often are thinking it's this sort of you know black art where we're manipulating brains um it's not that complicated we're just tapping into into normal uh learning processes in the brain so um let me give you an example if I could uh can I give you an example it's either in the I don't know anxiety or attention or maybe craving area what would be yeah craving craving would be good so if you drink alcohol um routinely you know several times a week after a few weeks or months of that the brain starts to make uh more glutamate because the Gaba released by the alcohol is so powerful it's so sedating that the brain is concerned about the balance of gapa to glutamate so it starts to raise the glutamate and if you then withdraw alcohol you know months and years later someone's left very shaky very unable to downregulate to soothe internally and this tends to produce even after a few months of chronic drinking this tends to produce a chronic overarousal state where somebody is really anxious they tend to Crave alcohol because it's the only thing that reduces the activation tone and and uh it really impairs sleep onset Sleep Quality sleep depth all kinds of things so very classic phenomena of using things like alcohol for some support and then they erode your regulatory stability until you're more anxious more shaky more activated than before which of course drives more craving so I see a lot of historically I've seen a lot of people who uh get into this condition and you can look at their brain and the brain is running lots and lots and lots of beta waves and the beta waves are all stuck together they're hyper coherent they aren't letting go and generally these people aren't able to get into deep sleep very well and the really hard part is often transitioning in and out of sleep you know getting into sleep initially is really tough so we do a combination of work with people like this we do um what's called SMR training or low beta training and we also do something called Alpha Theta these are different techniques but SMR is used to um fall asleep and sit still and also resist impulsivity so typically when working with uh alcohol cravings you want to think about the executive function aspects and maybe the anxiety aspects and work on those and then work on rebuilding the brain's like hyperarousal that it can't calm down again so uh we would start with executive function and sleep phenomena called an SMR sensory motor Rhythm if you've seen a cat in a window cell watching Birds you've seen SMR it's that liquid body and laser-like focus completely still physically but mentally on literally the opposite of ADHD literally um but SMR is also used to resist seizures to fall asleep and stay asleep to sit still to resist impulses so executive function is a big piece in uh disregulated relationships with substances you often want to bring up people's executive function sort of tone and that's again a largely a beta phenomena and it lives um on the strip of tissue that runs ear to ear the precentral gyrus is involved with voluntary behavior and if you look at somebody who is uh having difficulty with with with decision-making or executive function be it from chronic alcohol use or concussion or ADHD or chronic sleep issues lots of reasons what you'll see is the person's generally making too much of brain waves called Theta they're disinhibited and not enough beta or they don't have control over the beta the the low beta and in case of alcohol a lot of very fast frequency betas are instead dominating and so what you want to do is exercise someone's brain to bring up the frequencies this low beta that lets them sit still fall asleep resist alcohol Etc and most of that lives in an area of the brain sort of on the right hand side and it's a supervisor of what we're doing it knows if we're on the right Road it's reading the map it's navigating it's sort of telling the driver hey wait wait a minute what are you doing and so it pulls back on on Behavior that's more automatic or impulsive which is a part of craving so we generally want to train up exercise up this low Beta And so you stick some ear Clips on and put a wire on the scalp on that one spot and set the computer up to measure that low beta wave amount the amount one person makes moment to moment and also measure the amount of theta which is that disinhibited more automatic brain wave and as you watch the brain as the computer watches the brain the brain's going to shift a little bit moment to moment and whenever it shifts briefly in the right direction the Theta goes down the beta goes up computer sees that starts to applaud the brain and the brain's like oh hey stuff's happening kind of like stuff stuff's cool and then it happens to move in the wrong direction that Theta might go up again the brain uh stops getting its feedback the game slows down or stops the brain says Hey where's my uh where's my information that's kind of annoying nothing's happening then it happens to move again in the right direction and the Applause continues the big trick being we move the goalposts every few seconds we adjust so we're only applauding the movement in the proper direction and again it's mostly involuntary you can't feel your brain waves you can't really control them but somewhere around two or three sessions in the brain says oh oh oh you want some beta and it gives you an ni big surge of beta for a few hours and you walk around after the session going wait a minute might be feeling a little different huh and then it wears off and you're like I don't know was I imagining that that was kind of strange kind of subtle but I didn't notice something and the next time you train it happens again see then you're off to the races you have this iterative process of like gently pushing on your brain and watching what happens afterwards so you can iterate through making change and this low beta tone this SMR um again helps with things like executive function and sleep architecture but then with someone who's dealing with a lot of alcohol there's that you know Decades of learning around the inability to soothe and downregulate the inability sometimes to feel comfortable with the internal environment and of course we have the sleep stuff so we would typically in alcohol use a technique called Alpha Theta on top of SMR training so Alpha Theta brings people to the edge of sleep that hypnogogic access place where all the ideas and creativity starts bubbling up but you're half asleep sleep so you forget the awesome idea the next day um you can bring people to that state reliably using uh Alpha Theta Nur feedback where you have them close their eyes and reward the brain waves that surge in this sort of nonlinear deep deep relax relaxation State and in that state you're making huge amounts of te- cells growth hormone relaxing brain waves Etc and if you do even 20 sessions of alpha Theta the uh Cravings go away for people I you can see multiple standard deviations of change in a bell curve in resting brains going from like beta waves that are three four standard deviations off the chart to typical and somewhere around four to six weeks in people that are shaky and nervous and can't relax without major meds can calm down at will and fall asleep at will I remember the first time I saw this I was working in an addiction Center in Beverly Hills and we had clients with real significant alcohol difficulties um and this was a place that doesn't exist anymore more but this was a company that had both an abstinence track and a moderation track which is a really hard thing to work on sometimes in alcohol so I was seeing a lots of people at different stages of disregulated relationships especially with alcohol and one gentleman had been drinking for 25 years he would go to the beach in Santa Monica he was a writer so he would sit down open his laptop and drink a bottle of wine while he wrote a book or his articles and then he would go home and be a little activated so he drink more wine and Adavan and ambian to fall asleep and he would wake up two hours later wandering around West Hollywood all disoriented in his tidy whes and end up in jail half the time because he was you know on ambient disoriented and you know big scary man who was seeming confused and this kept happening and he would go from rehab to rehab he would have cravings nothing would work and he was in a rehab uh with with being medically supervised for a detox and he got through six or eight weeks of detox and he said yeah I don't think I'm going to be able to drink uh there's a brain Center over there across town could you guys drive me from the hospital to those guys I think that might be able to help and he walked into our office cold and we worked on him uh for a couple of months about six weeks in I walked into our office and he's asleep on the couch I said oh is he here for another visit I thought he already came in three times this week and the front desk person said yeah he called up this morning to figure out when you were coming in he came in half an hour early and went to sleep he discovered he could fall asleep at will I wanted to prove it to you so he's he's asleep because he wanted to prove he could turn his mind off and fall asleep at will all right let him sleep so it was such a huge thing for this guy he had to like rush in and take a nap to prove to us that this was a thing he could now do and he was you know about 67 at the time and it had been about 25 years since he gotten a good night sleep and month and a half in all that beta dropped away in the brain he could turn his mind off at will he could fall asleep he wasn't craving alcohol he wasn't well regulated yet the quality of sleep wasn't ideal yet you know all that damage all that stress wasn't yet rebuilt in six or eight weeks but it kept going and he kept making more and more change and was able to remain abstinent he he walked in trying to uh think about moderation you know because alcohol had been part of his life for decades but he ended up going to the abstinence track in that company and uh I think at the one year mark I saw him and he was had remained sober which was the first time in three decades he'd been sober for more than a few months so it can really reregulate this acquired problem I consider alcohol abuse an acquired problem in the brain acquired damage it starts with learning driven by anxiety driven by impulsivity driven by difficult emotions maybe trauma maybe sleep issues but that process creates change in the brain over time and then you end up with a brain that is sort of learned into a disregulated state it's really hard to back out of that without some assistance the brain doesn't like to recover from that hyperarousal state really easily um so I see these brain patterns in these folks that drink routinely even after they've quit drinking for 10 or 15 years you still see that same shaky active beta if they drank Daily Now binge drinkers don't show this pattern so college students you know 95% of them will binge drink sooner or later and 95% of them become problem uh become drinkers without a problem they they transition out of that problematic drinking but if you drink daily for even a few months that tends to change the brain really aggressive ively and it's a really hard thing for the brain to rebound from just on time and healing and so getting some good shifts like neuro feedback in the in play as well as other biohacks that might support you saunas ice baths um maybe natrixone or some you know other mu opioid blockers to reduce the reward uh nature of alcohol these are all useful strategies and I'm not here to tell any individual listening what they should do but I am here to tell you that you should do something you should take control over your brain if you aren't happy with how you're behaving or how your brain seems to be driving the bus you can learn about it and you can make these changes even when it's really extreme like Decades of drinking leaving you super shaky and disregulated the brain is really changeable you know shift happens you can typically back out a lot of these difficulties relatively quickly once you know how to apply pressure yeah yeah that's uh now when talking about alcohol um another situation which is related but but very different uh is people who are dependent on benzo aspenes like like you said like Xanax Adavan um Valium clopin those are you know the main ones and there's a lot a lot of other ones and a the majority of people on benad aines are not addicted to them they're physically dependent and and they may be treated like like they're addicted they may get sent to rehab and detox way too quickly and and they can end up with um long-term probably similar to what you're saying with alcohol where a person 15 years out can still have symptoms a person who comes off a Ben as Ain too quickly can be left with long-term uh protracted withdrawal and and even people going through a very gradual tapering process like I I work with patients who are tapering and even when they're tapering at their own comfortable rate and taking just very tiny little reductions they still have uh adjustments to make and and go through withdraw and um you know this sounds like it's I think it's similar you know with the the issue with glutamate and Gaba and that balance and um you know the whatever other recovery processes are happening in the brain you know that this might be something beneficial and another thing that's interesting is that people going through benzo withd draw often cannot tolerate any kind of medication so when you go to a doctor the you know immediately the response from a doctor is like let's give you medication let's try you know this or that and and see if that helps and they can have horrible reactions to to even a small dose of something that would be harmless to someone else and absolutely yeah yeah yeah so what do you what do you think about helping people with uh benzo withdraw and and long-term protracted withdraw yeah so um we have some good tools um neur Can generally help the system re-regulate I work with a lot of folks who withdraw from benzo's um and uh you can see in many people uh the biggest issue is managing the things that flare up as they withdraw so the pain the anxiety the Sleep disruptions um these things seem to be pretty common they're actually really tractable you can work on pain directly if you have breakthrough pain let's say or breakthrough anxiety as you withdraw um what I will say about neuro feedback and benzo is if you're on high levels of these things um it gets in the way of neur feedback it actually can impair learning so it's hard to do brain training on somebody who's on high doses of Xanax and other benzos um you have to sort of be able to have some clearance time you know only have them you know once a day or something before the neur febc is going to work if you're on huge levels I've worked with thousands of people um something like eight or 10 thousand people doing neura feedback and the only people and like three or four people total that I've not seen their brains move in two cases I discovered they were on very large doses of uh methodone or heroin uh impacting the learning essentially and the other two cases it was uh super high doses of benzos so benzos can really impair learning um and what's interesting is the benzo drug class in general makes the brain look anxious if you have benzos in your system you have these little spindles of beta waves which are really similar to the things someone feels when they're feeling that friction of anxiety that that's that's a little beta spindle you see it as a fast frequency beta wave but that's what Xanax produces as a side effect in the brain it's little rustic spindles so it's almost like your brain is producing anxiety that you can't feel while xana ax is on board so you can train straight through many many drugs but if you're on high doses of those drugs it can actually be really hard to get the brain to start moving but but a person who's on on a low dose relatively or even off of it for a long time manage dose yeah yeah either withdrawing or on a dose I mean I take your point about addiction versus dependence right addiction requires both tolerance and dependence and so we don't have probably this population described who's using it routinely you don't have the same tolerance you don't have the same need to ramp up the dose even if you are dependent at that point sort of you know physiologically accommodating it um these are things that will change if you know you can you can really wipe away the tolerance actually for many drugs it's not quite that reliable for benzo it's super reliable for stimulants someone's abusing stimulants and you have mean be it prescription or uh you know legal stimulants if you do neur feedback you wipe away the tolerance to stimulants really quickly and also to cannabis now the stimulants and cannabis are not abused the same way they don't cause the same difficulties generally that Alcohol and Other Drugs of abuse can cause but they're also lifestyle drugs that many of us take you know cannabis just alcohol um and you will get a potentiation so if you're on if you're abusing your arerol or you're on some sort of you know stimulant that you're you're getting into a little too deeply and you start adding neur feedback the drugs start working two three four five times stronger after a few weeks and as you may know moderation requires low tolerance so if you have super high tolerance it's really hard to moderate your substances but if you have really really low tolerance it's hard not to moderate so nerfing back is a tool where you can wipe away the acquired tolerance that you get and it really helps in a re-regulation so to speak with substances um it helps people get control over them again because they don't have to reach for the highest amount or the the continued dosing they can have a a bit of a different relationship with it over time yeah and that that's a good point with stimulants um with a lot of these other things we've discussed there's there's medication assisted treatment um you know for example opioids we have Suboxone and and Suboxone or buin orphan has its own issues of long-term dependence and getting off of it uh you know so this sounds like a good solution to help people through that tapering process of getting off of bubon orphin or suboxin um but then when it comes to the stimulants like um cocaine methamphetamine or even things like Aderall there's not really any kind of medical treatment or any good medical treatment to help people get off of them um right and not go back to them or or or be able to get through that that difficult withdraw period well of course you have with drugs of abuse you know we we we choose the drugs we double down on the drugs that serve some particular need like not everyone's into the same drugs and with the stimulant class if you're abusing them it's usually because you're you're impulsive Andor have difficulty with managing executive function it starts off that way often anyways it's also very rewarding the dopamine is very rewarding but if you give somebody a course of neuro feedback again you walk back all that tolerance so you create different relationships with stimulants over time and uh you also eliminate the reason people take stimulants at least prescription stimulants so impulsivity inattentiveness um trouble with speed processing trouble with uh waking up from sleep these are things that neuro feedback usually makes permanent changes in in a few months so on like a bell curve of of executive function um you can usually get a full standard deviation every other month with neuro feedback every 25 sessions roughly and if you take somebody who's really impulsive and really anxious and you give them control over their impulsivity thoroughly and drop the anxiety back to a natural response a lot of drug abuse just drops away because people don't want to be disregulated they're they're serving needs so if you pull the need if someone has no trouble falling asleep they're not super anxious and they're not impulsive behavior often regulates itself because people want to thrive they want to drive that sports car on the road not crash through the forest you know so once they have a little more control uh you generally see people's behavior shifting because the relationship with substances is allowed to shift um as their brain changes yeah and and and like you described this is way more advanced than this thing that I tried 30 years ago it sounds like you've you've taken out maybe the um it sounds like you do a lot more like you're actually mapping like where stuff's happening in the individual person's brain and and then the subject is not having to to sit there and focus and make something happen you know they they they can just sit back and is it that they look at a screen and see things happening on a on a screen yeah yeah we'll we'll throw up like a simple game a Pac-Man or some picture grid you know puzzle pieces that we'll fill in and the computer watches the brain moment to moment when the brain briefly shifts or stays shifting in the right direction the game play happens so little puzzle pieces filling in or a car driving or something and then the brain moves in the wrong direction and the game slows down or stops so the game's like making audio and motion at you you know stimulus the brain's like o stuff and then it slows down and stops and then it continues again the whole time you're doing neuro feedback in a classic sense these days you're watching games that are stopping and starting but the brain's hearing good job brain good job brain good job no good job good job good job no again and again and so it ends up being more about I don't mind this game versus I'm trying to do something and people often you know sit there and they try to focus they try to concentrate it doesn't really matter and then a few sessions in they stop trying and that's about when things start to happen is the brain goes oh oh oh you want some brain waves to do this and you get like a day or so of shift after a handful of sessions and you start feeling the after effects and it's really empowering to go well wait wait a minute I decided to do something and then I felt different in that way oh I mean even showing somebody with you know strong disregulated anxiety I can show you that anxiety in a brain map it's visible I can show you your perseveration rumination hypervigilance busy mind social irritability sensory integration it all just jumps out on a q when I show you your suffering it's not instantly different it hasn't solved problems right away but the moment you understand how it's working in your brain it's a whole lot harder to be overwhelmed by it shamed by it to feel guilty about this thing that's happening and knowing how your brain works can start to give you control over making changes so I encourage everyone if you're suffering you know don't just suffer in ignorance get into your brain learn how it works and it will often give you some strategies to take control I mean neuro feedback is a very high-tech and very involved process takes a few months you can make huge changes and it's really valuable I think but there's all kinds of things you can do once you know how your brain works if your speeder processing is off you hack your sleep your anxiety is off maybe do some bio feedback HRV or something meditation so once you know how all these regulatory resources are operating you can make better choices to gradually tune the system in the direction you want versus potentially just reaching for the pallative uh substance which is you know reducing some Drive of suffering or frustration or something but it's not necessarily shaping the machine in the direction that you want to shape it so if you're already reaching for drugs and alcohol you're already adulterating the system well why not do something to change it in a different direction you know take some control if you don't mind mucking about with your head maybe try to work on the anxiety and the Sleep onset and things like that instead of just feeling briefly dull and euphoric yeah so um there's I wanted to ask you about a few things that are maybe they're somewhat related uh if just you we go quickly through these few um um one thing that that what you're talking about reminds me of a little bit but I know it's maybe it's completely without the feedback part which is I think a major part of it is um binaural beats you know where where you listen to these recordings that that and Trin your brain into like uh you know and they talk about alpha beta theta Delta you know um and I do like listening to them like the Delta recordings and they'll put me to sleep and things like that but um uh can that I mean clearly not doing anything close to what you're doing because you don't have the feedback part of it at all um you know that you're not controlling it's not actually doing it's not doing what it says in the tin vinal beats do not create the brain waves they say that they create the the human brain does not appear to have a frequency following effect when you play two different frequencies in each year and the Brain picks up the difference that is demonstrated in some animals it's never been demonstrated in humans and lots of research looks for it and does not find it okay voral beats is another form of meditation you might as well listen to your favorite music the the Beats themselves do not matter monoral beats Boral beats it's all bunk it's all sham yeah so if you enjoy a particular helis sync or whatever V audio great now you're doing an audio meditation and that may have benefits but I would not spend lots of money on ball beat software or audio tracks because they don't do anything and I've done a lot of research in this both in Labs as well as in the literature it's a non-starter vinal beats are they're not quite as bad but you know there's certain things in the health and wellness space you should run from when you hear these words one of the words is quantum someone's using the word Quantum in a health and wellness context they're a charlatan unless you're sitting inside of an MRI machine basically um so Bal beats are in that same landscape you know the vast majority is just bad marketing bad science and there's not much there fun funny to say that about um because i' I found that some of the recordings that I like they work just as well for me if I play him on the open air over a speaker so um I'd agree with that that that it's more of a meditative so it's meditation yeah it's anchoring your attention which is useful and and and Powerful but it's not a magical secret Alpha track that you've gotten access to that's going to fix you so okay and and that would cover also the Mind machines which are similar we have headphones and flashing glasses um a audio visual entrainment um the light may do something it's kind of a weak effect um I think the old school AES don't do an awful lot a lot of them combine auditory and visual entrainment but light flashing light stem does something um we're not quite sure I I I think the way it can be used is to break up stuck patterns in the brain some sometimes but it's not a very strong effect and entrainment you know flashing lights and things creates some effect in the brain that goes away instantly when you stop the entrainment and there's no after effect so it might be doing something a driving effect with fic stem you know light stem and then there's good research emerging these days that you can do uh direct stimulation onto brain tissue using light using red light different frequencies of light will sort of supercharge the mitochondria's electron transport chain and feed it more strongly so it can whip around and make more ATP so I do think that some of these techniques that stimulate the brain are useful but the ones that have been around for 50 years are not the ones that are coming out now that are you know pulse red light or specific frequencies of light that go into the scalp and and feed the mitochondria um I think those are useful but unfortunately things like Bal beats and most of the auditory Visual and train devices um they're sort of tapping into a consumer need or interest in a mystery or a magic and they don't do much and they kind of charge you know a few hundred to a few thousand for that mystery yeah I'd rather you work with an individual who knows what they're doing and can guide you through some somewhat complicated stuff because there's a handful of things in the biohacker or health and wellness world that are just nonsense nonsense and and they're getting lots of money just to Rattle off a few sacred cows that I would like to kill here um blue blockers mostly nonex mostly meaningless blue blocking uh light doesn't do much the only Light That Matters for blue is first thing in the morning so don't wear blue blocker glasses it's kind of nonsense and things like non-native EMF somebody is getting ready to type in the comments right now angrily that I said that but non-native em EMF does not do anything to the human brain as far as we can tell takes an extreme amount of of energy to get through the skull the bone the fat layers it's really really hard to get energy in and out of the brain I spend all been decades you know 30 30 plus years trying to get electricity through that that threshold it's very very very hard you can even do like ECT you know stimulation electric convulsive therapy on a skull and almost all electricity goes around it not through it it's really hard to get in and out of uh those layers it's a lot of insulation so um yeah don't don't be too concerned about trying to find the absolute magical best biohack just start learning how your system works and make small Progressive changes yeah and and I think you might be alluding to this a little bit but um another term people here and could potentially spend a lot of money on different devices and techniques um poly vagel Theory uh what do you think of that um the Vegas ner and three branches and each they each do different things yeah I mean I think it's a valid Theory um I I think it's a bit more complicated perhaps than it needs to be for the individual uh you can really just think about the Vegas nerve being the integrator between the gut the heart and the Brain as it goes up and the Brain the heart and the gut as it go goes down and the guts beat to beat sorry the brain the hearts beat to beat timing the heart rate variability is the integrator of the descending information and the ascending information so you really can think about just the heartbeat the heart rate variability you know what happens in the Vegas doesn't stay in the Vegas ironically and you have this ability to train the heartbeat using biof feedback so that's a voluntary process you clip an ear clip on and you listen to your heartbeat mathematically lining up with your breathing called coherence heart Math Makes a Good device for this and that is huge heart heart rate variability is a valid thing it trains the peripheral nervous system and by doing that you can train the brain directly um so it's often a really useful technique either by itself or adjunctively with other uh bio feedback and other therapy so I'm a huge fan of HRV bi off your back it's definitely a legit okay yeah and there's there's a um oh what is it what's it called um I think it's called safe safe and sound protocol it's a a sound thing that was actually developed by by the um the guy Dr Steven pores who I think is the one who described polyal Theory and um where they where you you listen over time with with under the care of a therapist to I think it's 5 hours of of music programs where where certain frequenc quencies have been filtered out and they gradually reintroduce these frequencies and it has some effect on I think on a bone in the middle ear or something like that and um and it it helps with anxiety and and anxiety conditions and things like that yeah I'm somewhat familiar with it I'm not deeply familiar I don't really understand the theory behind it but I do know that all the safe and sound practitioners that we share clients with tell their clients not to do neura feedback oh because they think safe and sound is too powerful and nothing else should be combined with it I'm of the impression you should always take care of your brain and do things that support you but there's this sort of like my impression is there's this restrictive like don't do anything else if you're doing safe and sound coming from those practitioners and they think their stuff is extra special in a certain way so that's my you know from the outside world perspective I've I've I've done some of those techniques myself I've done some of the bone conduction listening studies uh looking at my own auditory function by some of those same practitioners but I don't really understand why they're uh using that technique and and think that it needs to be used in isolation so that's my my primary impression is not understanding that clinical end of the field basically okay and and then um just finally um some people go in for um uh what's what's it called the uh the thing it's not it's not ECT but it where they they use U TMS that's it TMS um now I would think TMS may or may not be helpful I've heard good and bad about it but um I would think a lot of people that might be thinking about trying it don't know about what you're offering and and maybe uh it's different yeah TMS is in TMS is useful but it's got kind of an narrow use case that's been proven out um couple things on TMS TMS is magnetic stimulation so it zaps the brain with magnetism and creates a likelihood or a reduced likelihood of the brain firing in the place it's uh Zapped um TMS works the literature shows that it works for depression that's about the only thing that it has good literature for but it works for about 2third of people not everyone and it produces a transient effect so it takes a few weeks or months to get the effect in TMS is actually somewhat painful for many people and kind of expensive um and then once the effect shows up you get a six to n month window of depression lifting and then it creeps back in So TMS I think I'm not a clinician I'm a scientist but my perspective on this is TMS is best used for acute medication resistant depression when you're in crisis to create some breathing room so you can architect other support for your depression it's not going to cure it as far as I understand neuro feedback Works more slowly and gently so you don't feel the process but it changes your brain so after you do three or four months of neuro feedback whatever you've gotten done is your new Baseline so it's a much more gentle process of teaching your brain to change and much less about imposing briefly a state and so I'm a big fan of neur feedback but I'm also I think TS can be very powerful and I know lots of therapists that use you psychiatrists that use TMs for depression and for OCD and a bunch of other stuff can be very very powerful but it's definitely a medical intervention it's definitely somewhat invasive and it has the the the costs of being kind of painful kind of takes a while and um it's it's very expensive to do TMS off unless it's insurance covered so I'm not a huge fan of things that are invasive only because I'm a scientist and bio I want you to do things that are gentle Progressive and only give you positive effects so I tend to lean away from TMS tdcs Tacs and all of the sort of more active zapping Technologies because they can work but they don't work any better than classic neuro feedback and they often work worse and they're much less controllable or predictable if you get side effects neur feedback if you get a side effect and that happens you might train the brain and feel weird afterwards feel wired or tired and it wears off later on that day or the next day you're back to where you were and you're like that was kind of weird I felt kind of wired after that okay let's adjust so other techniques might be more pushy and harder to adjust as you go so I'm a big fan of this gentle iterative slowly move yourself in the right direction versus aggressively impose something from the outside all at once so I have seen TMS work but unless you're in really acute crisis you're medication resistant you tried lots of stuff I'm not not sure it's the best solution I'd almost rather you start doing sleep hacking and track your uh your stress response and your mood do some HRV bio feedback maybe some neuro feedback those are all likely to make changes cheaper more rapidly in a less adversive way and safer yeah yeah there there's also a lot of excitement now of um about psychedelic therapy in including um ketamine which is not really psychedelic which is but it's available now and then upcoming things like psilocybin and and other things of course you know we're we have the where we have the option to not use a drug for treatment that that would be ideal uh especially like I said with the the B of aspine tapering and withdraw patients they cannot tolerate drugs so we can't say you know we can't say tramy I mean we can it does help some people but it also uh does cause a reaction for for people and I definitely would not tell anybody uh tapering off a Benzel ASP even consider using any kind of psychedelic drug because that would have a horrible reaction um besides somebody who's had a disre relationship with substances for a long time they have many times there's this part of the problem may be sort of an external locus of control looking for Solutions outside to fix the thing um and that means that you might go from one drug to the next looking for that magic I I have clients who come to their feedback because it's a tool and then I'm watching them talk to the psychiatrist and shift medication every two weeks looking for something to create some new experience and it's not that there's something that there's some big suffering they're trying to fix they're just looking for like the magic or the or the The Edge that's that's kind of risky there's nothing that works that way for people so um back to basic principles get the resources of sleep stress and attention sorted out and then the other stuff tends to take care of itself yeah yeah that that switching of medications switching psych drugs I I think is not not only not helpful but highly traumatic for a lot of people you know you're kindling you're traumatizing the the central nervous system by here's one drug let's pull it away give another drug and just having overlapping withdraw and toxic effects it's it's really a bad idea to go from one psychiatrist to the next and each one changes all your drugs every time it's huge it's it's a big problem and and you get these poly Pharmacy effects where folks are seeking multiple drugs from multiple providers and it causes major problems you know what I will say about uh uh prescribed substances prescribed drugs especially anti-depressants and things is brain mapping show you how those drugs work in your system actually not just anti-depressants but stimulants if you're wondering if your alol Works do a map with and without it you can see it working it's really obvious and uh things like anti-depressants which are hard sometimes to get a good fit with with people about 10 or 12 days after you start taking an SSRI you can see the changes in the brain that are going to show up and be felt a month later so you can get an early screen and figure out what direction the drug is pushing you in sometimes too or you look at your caffeine consumption or alcohol consumption and look at real time what is it doing the speed of processing anxiety features executive function features performance and I can't tell you the number of sort of dirty mapping or or contrast Maps I've done with folks I have the clean one and the caffeine one or the Aderall one the Cannabis one the alcohol one so many and what here's one thing about brain mapping or qeg when I teach you about yourself using your own brain data I'm not telling you anything thing you don't already know usually you're like hey here's a thing which often means X you're like yeah that's me okay over here this can mean y oh yeah I experienced that so when I show you your brain clean and then with you know a substance in it you're like oh yeah that is how I feel with that substance and it can be really crystalizing for your relationship with some of these compounds so you learn take agency yeah learn about your brain no no with with ketamine uh they they claim that one of the one of the effects of it is uh neurogenous where you have the the dendrites you know the the little spines between the uh the things between the neurons that connect and communicate that those will grow and form new connections uh could neuro feedback be used synergistically with ketamine therapy to get a better result than you might get with either one uh separately possibly sure sure um but you're you're remodeling dendrites every day all the time anyways yeah I mean if you went and did one piano lesson every single hand area every single cell has moved um in the hand area with one piano lesson um and plasticity is always happening even someone who's in their 60s and 70s is making six or 700 neurons a day so you're not really ever at a lack for plasticity this is one of my complaints with the the micro doing you know psilocybin stuff is everyone's doing it to bring up plasticity you don't need more plasticity you need to shape it yeah I'd rather you sit and meditate for 20 minutes a morning or 10 minutes a morning or go for a walk which is hugely plasticity supporting do some neuro feedback so again it's that seeking the external solution uh I think a lot of folks are like oh here's a thing it's magic it's my Edge well no it's kind of a disregulated relationship you're looking for a thing to support you but might not be so um yeah I the the the ketamine reset thing um seems to only happen if you have the infusions too so these days there's a big push towards the uh lenes which are escam Meine one half the molecule but they're not just don't have the same uh sedative effects that regular ketamine has and it seems that that dissociative event is what causes the strong Surge and plasticity so I know it's not the same mechanism of action at all but I kind of consider ketamine very similar to ECT it's like turning the computer off and back on again to get it to sort of reboot and create some more plasticity yeah um and I think that you know ECT works just as well and these days ECT is still done with ultra low voltages and currents a very small amount of electricity compared to where it was you know 20 30 years ago even and it works really really well for medication resistant depression really well but it has this you know perspective from the 50s and 60s of being shock therapy it's it's a different thing now but camine in the same landscape where it creates a really reliable lift of of major depression um and then some people get rapid relief from the inhalers and the lenes but the effect is really reduced in that molecule in the S ketamine compared to the regular ketamine so I think it can help but I'm I'm of the opinion that it's an intervention it's kind of like an ordeal it's a shamanic experience you know you might as well go and have an experience and have some healing and reintegration afterwards and now it becomes a lot about the people you're doing it with and support you have and the after effects and the integration I think that's more important than is ketamine the magical thing is my psilocybin is my you know EMDR whatever the the the sort of shake up the etches SC thing is I think that the the set and setting the support the after effects the integration are actually somewhat more important than did you find the right drug oh yeah to you know yeah I agree I think that's crit critically important and people should never do any of these things of course outside of a clinical setting right so right exactly um now as far as the U neuro feedback um like how how would I um like you know you're in LA and I'm in Fort lauderale Florida uh and and I know that not everybody most there's not too many places probably that have um these brain mapping uh facilities and people that know how to use the equipment and the proper equipment uh where where can I find that or where can anyone find that so there's about 15,000 people in the world that do neuro feedback which isn't that many there's probably 15,000 chiropractors here in La you know but um Peak brain Institute my company we have offices in New York uh St Louis La Orange County Stockholm and London and about 80% of our clients never visit our offices we do most of our work from home so we send people brain mapping systems put put cap on your head squirt a full of gel and do a map with you from home coaches will guide it live and do real-time data acquisition and the coaches work with you for a couple of weeks and help teach you to stick wires to your head and set yourself up for training the brain and we work virtually every client gets a private slack Channel and everyone has real time 7-Day week communication so Peak brain is kind of like the soul cycle model for brain training we send equipment home and coaches and screens cheer you on and nag you to do stuff and help you move through it so yeah we're mostly virtual we have all clients all over Florida we can work with you no problem what what I have to get a hair cut or something or or you would not you actually having thick dark hair is the best flavor of head to have a good EEG like my head my bald head you can find locations really easily it's actually hard to get clean signals off my head because the the the pulse moves the scalp which adds noise and also you have a thicker layer of fat and oil if you have a bald head and it creates insulation so the best EEG uh the best scalp for an EEG is somebody with a thick head of dark hair oh wow so it's great I I love people with lots of thick hair it's hard to get an EG if you have like natural um dreadlocks or some like really thick hairstyles you can't use caps then you have to place individual wires throughout the scalp that way and I do that all the time with people that have you know uh black hairstyles in the US for instance but generally it's not that hard to stick a cap on the head you're s it full of gel so the gel is touching your scalp you don't have to like stick wires in every place and then that's the assessment which is a little awkward little involved to jelp a whole cap but the training process is a couple ear clips and one or two wires at a time so we teach you to find location stick them on set the software up get your session in and then give us some reports afterwards and move you through that uh like a personal trainer would over the week oh like if a person is in a location near you like say in New York uh St Louis or La can they come in in person and do it also yes yep yep they can come in uh we train three times a week in our offices but we encourage our home clients to train four times a week oh you have the gear you got the brain we have coaches so we get more sessions in for the same amount of time so I have a two-month standard program people start with in our offices that's 25 sessions you three times a week and from home it's uh four times a week so it's like 32 33 sessions and we charge the same amount in office and home use the same software the same Hardware the same coaches so this is part of why my clients who are even in LA and New York often train from home because they can train at 6 PM they can train on a Sunday they can ask for real-time help and they don't have to worry about driving to an office sitting down giving a report getting set up leaving so the whole process becomes much more uh integrated into their life and they can sit and do homework work or their taxes while they're training and then just you know check in with us later so uh another the home training the the remote Nur feedback is a big thing that we tend to do even in 2019 we were about 50% remote but during 2020 we went up to about 75% I'm not sure it's dropped since so yeah uh yeah you are in the world I agree any anything that we can do from home is is always better I just didn't realize that that you had this technology to the level like where you could have someone do this at home Cu uh you know back back in the old days you know like when I when I did that thing I went to the neuro or the biof feedback or whatever they called it they were you know shaving little parts of our scalp to to stick electrodes on yeah you don't need to do you don't need to do that these days and we can give you a laptop bag with an entire kit preconfigured when I got involved in the field you know 25 years ago you actually need two computers to run one session because one ran signal processing one ran a video game you tied them together with a parallel cable and it was like $112,000 of computers in 25y old money you know it was really expensive to get set up now you know uh for folks who are watching this is an EG amplifier we Ed for training it's under a grand for the hardware and the software costs about the same so we just lend people systems so you get a whole laptop bag and you return it when you're done but it's not as uh technologically expensive because it's more consumer-driven hardware and software these days oh so so people have access to this from from anywhere they do yep yeah if you're in the US Sweden or the UK you can come to one of our office get a map or do a remote map and then train remotely if you're in a different country um we don't have rental programs so you might have to buy a system or I can find you a place to get brain Maps but yeah I work with clients all over the world in 20 or 30 countries uh and even in the US you know most of our clients are not near Southern California New York City or St Louis so we end up getting uh most of our clients virtually and I do a lot of podcasts so people find me randomly all over the world and you know the top of funnel so to speak is really wide so that's part of why we stay virtual is because people are like I want to work with you and I'm in this place okay great and we learned how so that's great and and I'll put it of course in the show notes but what what's the best place for people to find you like online your website yeah so we're Peak brain institute.com you can check us out there all of our socials are Peak brain LA because that was the first office and you guys can also check me out on YouTube it's just youtube.com Hill drill and I do a weekly live stream every week where I'm doing their feedback and answering biohacking questions so if you guys are curious show up and ask questions oh that's incredible okay uh thank you Dr Andrew Hill thank you for joining me today oh it's my pleasure sir thanks for having me e