Exploring Neurofeedback and Peak Brain Performance with Dr. Andrew Hill

so um today I'm talking to Dr Andrew Hill um welcome Andrew it's really nice to meet you and I look forward to seeing where our conversation goes today thank you thanks for having me nice to be here yeah so I thought it would be good for us um to start by you telling people a little bit about yourself but mostly how you decided to become a cognitive neuroscientist and specifically what was attractive to you about um neurofeedback ah so so cognitive Neuroscience for folks that are wondering you know what that mad scientist kind of label is cognitive Neuroscience is typically get something in the in the brain how it works by overlapping physiology with performance in some way assessing both seeing with an overlap and then learning something about how something works like attention or sleep or stress or anxiety and I studied that in grad school but the reason I went back to grad school to study this aspect of the brain was because I was working in this field of neurofeedback and found that a lot of people were getting a lot of change so I I started off working in Health and Human Services many many years ago um and I've worked in every aspect you know inpatient crisis work geriatric dual diagnosis with substance abuse I ran uh group homes for several years in Massachusetts with folks that were multiply disabled developmental no language motor issues deaf or blind I mean just people at often these sort of edge cases of where human suffering can be across all kinds of stuff and I got injured working in a psychiatric hospital I was in charge of doing restraints and handing the heading up the teams that would show up in the sort of unsafe environment and try to get them to become safer and the hospital system uh was in the process of sort of collapsing the payments for inpatient mental health were going away and this was a long time ago now uh in the in the 90s right uh and I left um mental health for a little while because of that and when I went back into mental health a few years later I ended up working in an Autism Center I had a lot of experience with autism and ADHD and things and it was a center that used primarily neurofeedback to train the brain and I had deep experience with kids with Developmental atypicality and all kinds of things and I was blown away by what I was seeing happen in these uh these clients this in this neurofeedback environment were folks with via ADHD were having it regulated in a few months and folks without language or with dramatic sensory issues we're seeing shifts of those resources in a few weeks or months sometimes and this really flew in the face of what I thought we could do I mean I spent so much time working in acute inpatient psych where folks had this revolving door phenomena coming in becoming stabilized and not really healing or getting better for while I worked on a latency age an adolescent unit where we had kids from four to ten and then from 11 to 16 inpatient psychiatric and those folks who take them out of the environment that's just regulating them and usually people rebalance they become very resilient but we I saw people going back out into their dysregulated environments with you know difficult socioeconomic stressors and uh disad disadvantages with regards to education and crime and poverty and all kinds of things that really got in the way of Mental Health Management and then when they were inpatient it was just taking out some of the harm and then usually managing some suffering briefly before those people went through a whole nother round and repeated the same phenomena so usually it's a symptom reduction not really long-term growth and change right yeah and this was at a time when the average inpatient stay as paid by Medicare Medicaid and other you know phenomena the big blues uh was 11 days on average when I started working in an inpatient psych and over two years the average length of approval dropped to two days that's nothing it takes three weeks for ssris to start working when someone's acutely depressed sometimes and when someone's in crisis you don't even get the the drugs to stabilize in two days now right yeah it's it's really criminal I would say on some level but um I'm curious about well I think it would be useful to talk about what neurofeedback is exactly like how does it work and what does that mean yeah neurofeedback is a process of training the brain training the central nervous system it's a form of what's called biofeedback a lot of folks here biofeedback and think like relaxation work and hand warming and you know breath pacing and things and that's a way of taking control of physiological stuff but when we say neurofeedback we mean the stuff you're trying to controls inside the bones it's inside the central nervous system and one of the biggest differences between peripheral nervous system and Central is you can't feel your central nervous system it has no sensory nerve endings you can't actually feel your brain ironically because it's doing all the feeling um You probably wouldn't want to feel it it's kind of acidic and hot and moving actually so it's probably a a mercy we don't feel our brains the way we can feel our heart and things because it would be way more painful but the process of doing neurofeedback broadly is just picking up something inside your brain that's varying like the amount of brain wave the speed of a brain wave or some blood flow or something and then reflecting it out in a way that is almost brought up to the level of not awareness necessarily but the brain notices it because the brain itself doesn't really the brain doesn't do very good monitoring of its different parts part of the um the mechanisms of information flow in the brain require that the brain be very modular and information that's that's being processed is kept apart from other bits of information so in like glandular communication endocrine communication the body you release endocrine molecules into circulation and they act for a long time at a distance gradually with very low timing Precision but in the brain you release neurotransmitters into the synapse and not into circulation the synapse is actually a closed space between two neurons let's say it's sealed off in a little little opening area so you're controlling the concentration of neurotransmitters in the little little gradient so the brain's very bad at knowing what other parts of it's doing there's no like Central management of the brain itself that can kind of go oh wait over there that's kind of a seizure I should probably pull back on that there's mechanisms for managing stuff but no high level so we take some basic features of associative learning and hijack them a tiny bit take things that are happening and measure them so leave an example um that's sir Germain to neurofeedback the field was discovered in the 60s the way it's done now because of a brain wave that was sort of um trained it was it was exercised at UCLA Dr Barry Sturman was working with cats and found he could shape he could operantly condition this brain wave called SMR or sensory motor Rhythm and we all make SMR if you but you've seen a cat on a windowsill holding still and watching Birds you've seen the sort of pure case of it where you get a lot of motoric or body inhibition and a Stillness of your focus which is literally the opposite of ADHD literally which is a low SMR State relative to Theta or a lubrication or release State the brain can produce in its modules so if you stick a wire on a circuit involved with uh not being impulsive or with sustaining your attention when you're bored that's the right hand Central cortex left hand you can measure moment to moment the amount of these beta waves measure moment to moment the amount of things like thetas and Alphas which can get in the way of control and whenever your brain happens to move briefly in the right direction the computer sees that and applauds your brain with a little bit of gameplay so when game starts to move Pac-Man each dots or puzzle pieces fill in and the next moment your brain moves in the wrong direction and the game slows down or stops the brain says hey hey Mike where's my input where's that stuff I like stuff oh and then it happens to move in the right direction and the game resumes its little Applause good job good job brain nope good job good job good job nope again and again and the big trick here the operant conditioning piece of it is we adjust the goal posts every few seconds we move the threshold the the criteria next to where you already are so your brain gets Applause for movement it makes in a certain direction from its own brain waves it's not an active process it's usually fairly passive in most neurofeedback and the Brain goes well that's interesting bringing my Theta down and SMR up does stuff cool but the Mind actually takes a few sessions of training to feel it within about 10 minutes the brain's actually picked up the information Loop and it's starting to sort of Echo and mirror what the outside world is telling it it's really kind of interesting people don't feel it yeah we are so adaptive and that mechanism is so sensitive to shift and change is there is there an effect of the act of being able to watch one's brain like that um there can be especially for some of the the physiological parameters that you have control over like blood flow you actually have a tiny bit of voluntary control if you think happy thoughts or concentrate you got a massive surge of blood about two seconds later you can wear an infrared sensor on your forehead I have one here I do you can throw an infrared cam on your forearms yeah of course I do right and measure waves of heat coming off your brain in real time as a like a vascular tone and concentrate or think happy thoughts and see it surge because the act of seeing that surge therefore then impact the physiology not directly I mean a little bit but no mostly it's involuntary training most nursing back is passive involuntary I mean the cats that Sturman condition cats are really bad instruction followers yeah this works if you're unconscious it works if you're in a coma Dr Margaret Ayers who died a few years ago was really well known for training people who were in comas and training people who are unconscious quite a lot and getting changes in brain so so then the the feedback loop of watching one's processes is not really impacting the process um no well it is because the pro I've seen the other way around actually the process is adjusting itself to react what the brain is doing so yes but the loops are on the other direction actually yeah um what does affect you dramatically is not the training often I mean yes the training impacts you quite a lot for some numbers if you train those circuits on the left and right I mentioned we typically get about two standard deviations of change and ADHD features in about three months which takes severe ADHD and just takes it to the to the other side of the bell curve office that's remarkable it's a big change and it's very robust and it's very replicable and you see it you feel it so it's not this mysterious process ultimately yeah um yeah I know there are different types of neurofeedback systems and um I wonder about that like for example brain paint was sort of all the rage around the mid 2014-ish um so just for people that are listening to this and getting excited about it how would they go about choosing the right form of neurofeedback yes good question um brain paint I have a lot of respect for uh Bill Scott at UCLA who helped develop it um brain paint is a semi one size fits system where you answer questionnaires about it and it sort of picks from a set of protocols and initially at least um the brain paint was picked up a lot by inpatient addiction centers because you could do good neurofeedback it's very impactful for cravings for alcohol withdrawal for seizure so you could do fairly good neurofeedback for that population executive function sleep stress anxiety all this that gets in the way and creates dysregulated relationships with substances you could do stuff for people very effectively with a sort of menu driven approach and that's what brain paint has done but it's not a specially well tailored to your like actual physiology you don't do an assessment of your brain and I would say half the field two-thirds of the field um still works in this area called quantitative EEG or qeeg and that is where and this is actually I think what changes you when you engage with a process the most is so if I show you your brain and then tell you a bunch of things about yourself that are already true and you know them but now you see them if I show you the anterior cingulate kind of lit up in high gear and I say you know that when this happens sometimes people get obsessive or a bit you know stuck in their head for separate oh my gosh wow I have OCD oh okay there's your superpower getting stuck um oh your back mid lines kind of stuck are you kind of threat sensitive and oh you are we do ruminate oh some trauma history oh I'm sorry experience that God we're seeing it yeah you know because now you have this opportunity to stretch it you can stick a wire on the back midline measure the posterior cingulates like tendency to go watch the road watch the road and yeah that is beta waves moment to moment and measure the alpha tone the softening of that circuit where I can put its fist down and you can teach your brain to stretch out the resource and it's like ah subjectively and you feel it happening yeah it wears off a few hours later and you talk to your coaches and say well I think I noticed some really interesting calmness right try it again and it builds up again so the metaphor here for neurofeedback is personal training but the real change starts even before you get changed once you sort of conceptualize your suffering as physiology it has a label not as things happening to you yeah you're a therapist or a clinical role you create transference this is container there's relationships expertise this treatment I'm a coach I'm a PhD scientist my job is to educate you teach you stuff and thrust agency back up on you go forth and transform here's some tools come back and and we'll celebrate and cheer you on and negative you more and and whatever else but it's a very different relationship when you're becoming your own expert and that's sort of our different play into neurofeedback is the yeah I mean that's beautiful it sounds like in a way from the metaphor would be a biomechanical approach where you're stretching muscles if they're tight and then they they're adaptive so they go back to being tight again but the more you stretch over time the more Nimble and loose uh they become so these systems instead of being jammed up or looping over time start to relax that pattern is that an accurate I think so I I think the metaphors sound because most things we suffer from anxiety executive function stuff sleep dysregulation um is actually closer to a resource that's spasened or gotten stuck in a certain regular regulation mode it's not really a disease process right there's a lot of suffering involved with all kinds of psychological and physiological things but an awful lot of the brain stuff is not really Progressive disease things it's an over adaptation or an accommodation to something so so um so I think you answered the question about what EEG does exactly like how EEG is different from biofeedback yeah yeah so bio feedback is an overarching term and then EEG neurofeedback is one of the forms of it on the brain but you can also do EMG on a monotype muscle or you could do uh heart rate variability on the vagus nerve which controls the heart you know beat to beat variability which integrates the arousal sympathetic versus Power sympathetic balance so you might that's it for a biofeedback which we do as well Peak brain is focused on integrating sort of programs for you towards your goals because we're not diagnostic it's all it's all your goals yeah so we'd include heg or HRV biofeedback or EEG neurofeedback mindfulness education we might teach them to use a sleep tracker or we might teach them to use an acetone meter to do macronutrients or functional Neuroscience biohacking where you learn to control like insulin resistance and sleep strategies to get better brain health and then you see those things change on your brain Maps later on that's really extraordinary so when you talk about biohacking and Peak Performance what are you talking about there and well I guess in part what I hear you saying is that people have conditions that we consider pathological meaning problematic whether it's ADHD or OCD or high anxiety and that Um this can help enormously with that but what if somebody is pretty regulated and they have strong executive functions and they feel fine um how does that tie to what you're calling Peak Performance yeah well first of all people are weird be weird so when I'm looking at your brain compared like population averages it's not like why aren't you average Let's Make You Average it's more like hey here's a yardstick here's how you stack up against it here's a few things that jump out and when it comes to Executive function testing we always do plastic cpts which are very valid for executive function going go style tests those are okay straightforward compared to the average person your age here's where you're impulsive here's where you're inattentive you've got some auditory versus visual it's stamina issues whatever but the value there is unpacking the physiology the performance below the level of the label so it's not ADHD it's impulsivity or an auditory processing issue or reaction time or something but then you end up with like a particular set of all that's the bottleneck interesting oh my wow my my teacher says I'm really really ADHD and I can't sit still and I'm always moving and look at the person's brain and their executive function is fine for the first 15 minutes of a test but it burns right out in the last five right famine issue not really classically ADHD look at their brain you don't see ADHD which is high Theta instead you see lack of beta and draggy alpha waves and the person's kind of anxious and you kind of figure out they have sleep maintenance issues and they're generally anxious and they're have fatigue and stress kind of fighting each other all day long and they're Brill and reactive not squirrel not hyperactive but you can't always tell the difference in a 14 year old who's stressed out so the maps and the tools can sort of give you this and and not just like give you like a particular intervention of neurofeedback but start to unpack hey wait a minute here's what's going on so if you see that your Alpha Speed is running slower for your age than the average person is if you're above 30 or 35 you probably have word finding issues delayed recall and tip of the tongue and hunting for Stuff but that's actually not aging related memory which everyone thinks it is aging related memory stuff which usually doesn't happen before age you know late 60s but age-related memory stuff the first thing you lose is episodic memory or first person perspective experiences you don't lose words and names and semantic information if you have Alzheimer's or parkinsonian dementia or LBD or something you lose the semantic and word information well after you're far gone so don't worry about it word finding delayed recall you're reaching for loading stuff into your mind into working memory and you're having handoff mismatches timing mismatches you're grinding your gears so I can usually predict if an adult is having word finding issues because the alpha speeds are all desynchronizing and if a kid's having that they run so fast that finding words is fine they have trouble absorbing information from the outside world so I'll say oh you're reading a book and discover 10 minutes in your mind's been doing something else for eight of those minutes wow yeah because the intensity dips and the speed the there's nothing to synchronize the information flow anymore so when you see these things it's not like oh and now I'm doing our feedback I mean yes you can often do that and if there's suffering if there's a cute stuff you got big goals great there's a there's a hammer we can hit some nails but for other people it's like here's some agency oh you just had covet now I see Delta everywhere oh that's really uncomfortable um good strategies try keto there's a hyperbaric placed on the street really hack your sleep um really really watches you know oxidative stress things you know let's let's see how you look in a few months you can now track metrics the same you might look at your lipid panel at the doctors and go oh better back off in the bed and Jerry's for a few months yeah it's just agency you just learn yeah well that's beautiful it sounds like it's really a holistic approach that you're looking at the whole person uniquely as they are because everybody's so different they are people are weird lovely lovely people are quite weird yeah that is mindfulness um practice fit into this process because you mentioned that also or how does it complement these processes yeah so mindfulness um of course for folks who are familiar uh it's it's getting ready all the rage so I'm probably not telling anything anyone knew but um I consider it so the classic definition is I think this is maybe John Cabot is in said paying attention in a particular way to the present time on purpose um the act of meditation or mindfulness writ large is actually one of executive function which people often don't realize until they do a bunch of it it's not an act of relaxation you don't go to the gym and be strong you go to the gym and be weak and later on you're strong you've got to meditate and you're distracted as heck and your mind's wandering and your knee hurts and she's cute and oh my stomach's rumbling that's what happens when you're meditating or doing mindfulness and many forms of mindfulness are an anchor or an executive anchor to take the prefrontal cortex and they help you direct executive function on single point of awareness on present time flowing by on a Feeling tone they're an active executive anchor so executive systems are one of the big three things that tend to want to have a beautiful foundation for Sleep stress and attention attention being the executive as things that scaffold all the other higher level human things and there's no mood thermostat in the brain but there are measures for Sleep Quality and executive function maintenance and things like that so train those and the whole system tends to resolve so it's foundational and fundamental it's also something you can do voluntarily most neurofeedbacks involuntary you get to choose what to work on and then say if it works as you as you iterate you don't get to make it not work you can't make it not work in the chair your brain gets moved right you go well like how I feel or oh I feel a little weird and it wears off you tell your coach but it's it's involuntary exercise so we want this voluntary piece of it while the neurofeedback is like the coach in the gym helping you build resources the mindfulness becomes the coach in the field helping you realize you're dropping your your shoulder or something when you're trying to execute and you learn to navigate and integrate the voluntary resources and we make that a big piece of it you know all of our clients get mindfulness training if they if they wish or if we can talk them into it and we have weekly groups as well that are both online and in person um since we are working with your mind and your brain I feel that that's the sort of minimal piece we should be doing for clients who might have others particular cognitive and you know deeper stuff they want to work on often when people come in with diagnostic language based things they've also got other team members which is great so I'm not going to work on schizophrenia without a psychiatrist on board or something but when someone comes in who has a lot of desire to transform and change their brain I feel that some guidance with that and some structure some Community can be very very useful so all the clients got some direct instruction but then they get this weekly group so you know you can do that during neurofeedback although I often recommend it especially with anxiety our mind folks later on oh you finished your program you're feeling great oh don't forget you have these mindfulness private sessions available in this weekly group and oh yeah and then we create follow-on healthy habits and behavior in a sneaky way and we also um our physical offices we have four in the US and a couple popping up overseas now our physical offices are set up with a membership set up so that people pay one time and they have access throughout the year for brain mapping so they often do this thing where they work on their ADHD or their postcovid fog or their seizures their migraine or their creativity or whatever and get through it in a three to six month time frame and transform pretty deeply and then we want to provide this longer amount of continued agency continued habit hacking and and doubling down on things so that fixing your sleep issue translates into better sexual performance a few months later when your cortisol drops for instance you know like these things are foundational we don't want just to stop when you're done the problem for yeah so again I keep hearing the holistic approach to um brain health and well-being and um speaking of sexuality because I am a clinical apologist I wanted to ask you about how these processes might help to optimize people's sexuality or not their sexuality but their sex and their sex life specifically inhabiting your own sexual identity nature expression Joy pleasure is really complex across people and honestly while there are some things specifically we do that have sexual sort of uh targets with neurofeedback I treat a lot of sexual complaints when people come in sometimes performance complaints or uh sleep issues or I mean often a sexual problem when I'm hearing about it is angling anxiety landscape or it's a parasomnia or dysomnia someone has like an uh middle of the night arousal phenomena that wakes them up that actually happens to some men where they can't fall asleep because an erection wakes them up and they are like have a like it's almost like a tick essentially yeah um so I see that those people I see people for whom performance has become very stressful and it's like any other flavor of anxiety and I see folks the other big thing I see is folks um women in their late 30s and 40s who are trying to do everything they can to get pregnant and cortisol gets in the way of that so someone's got dysregulated sleep and they're stressed and they'll you know their their fertility black will say you know addressing your anxiety or sleep issue would do as much as the hormones we're doing so you should probably you know bottle feedback and they find us that way so I tend to see the sort of the sexual piece of it for folks in the larger goal landscape and you know for folks that are anxious the goal tends to be about different flavors of anxiety or perseveration or maybe social anxiety or maybe trauma history yeah you know and it's about Detachment stuff now not really about the sexual it's about the attachment perhaps and you can do amygdala type you know uh massaging essentially right and then for other folks um you know you have these quirky weird brain things like night arousal phenomena or sometimes you get folks with post SSRI depersonalization in anhedonia and low sexual tone because of that and not all these things are super tractable in the neurofeedback landscape but now you can really get good impact on anxiety Sleep Quality and plasticity in the brain which can do a fair amount for helping then you know narrow the landscape of things you're trying to work on yeah and then you can be a little more specific and you can be a little more you know uh targeted with trying other interventions as you need working with that person on the post etci working with the fertility doc on specific interventions because you're no longer trying to you know Drive cortisol down because your deep sleep is suddenly regulated or you know whatever so yeah all right great well that's really interesting and useful to certainly those people who um come to Center for healthy sex for treatment so um Dr Hill where will people find you I know you said you're in Culver City right now but where else are your offices around the world and how can people locate you wherever in the world they are yeah so we're in West LA of course in Culver City we're also in Southern California and down in Orange County in Costa Mesa we also have big offices in St Louis and we have one in New York City in Manhattan we are right now opening up we have concierge technician in London and we have somebody in Stockholm and uh there's a few other cities we're in but actually 80 percent of our clients never see our offices and we send them equipment and our coaches do brain mapping virtually and we give them amps and we have live people seven days a week to teach you to do neuro feedback on your brain and troubleshoot what you're doing and hold your hand as you set up wires and curse windows for having done an update just then because it does that that's fantastic right um so we are again a personal trainer type of phenomena so we tend to support you know we have these physical office Network and folks come and map their brains and fun with it but you don't have to be near the offices to work with us if you want to find us on the socials we're at Peak brain La almost everywhere but our website is Peak braininstitute.com so come check us out and share your brain with us and uh we'll be happy to show you all that stuff that's great well it sounds like you're doing really cutting edge and exciting work um and so now everybody knows where to find you so it's been my pleasure to talk to you today um and if anybody has any questions please feel free to either write to us at centerforhealthysex.com or you could find uh Dr Hill at Peak brain Institute all right thank you of course my pleasure thanks guys take care of those brains