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Mapping and Fixing Your Brain With QEEG and Neurofeedback (Dr. Andrew Hill)

Make sure not to miss the great offers in Biohacker's summer sale! Check it out: https://biohackercenter.com/ QEEG or EEG Brain Mapping is an assessment tool used to generate hypotheses and identify likely performance bottlenecks in the brain. This presentation will give an overview of how QEEG can be used, the history and some limits on QEEG, and how to identify features in the brain that are most likely to improve performance when addressed. Dr. Andrew Hill is one of the top peak performance coaches in the world. He holds a PhD in Cognitive Neuroscience from UCLA’s department of Psychology and researches attention, cognitive performance, and peak aging. Dr. Hill is the founder of Peak Brain Institute, host of the Head First Podcast, Lead Neuroscientist at truBrain, and a UCLA Lecturer teaching courses in psychology, neuroscience, and gerontology. This presentation was filmed during Biohacker Summit Stockholm in May 2018. Check https://biohackersummit.com​​​​​​​ for upcoming events & tickets!

Episode Summary

I gave this talk at the HOLOLIFE Summit (Biohacker Summit) in Stockholm, walking through how I read brains and how I work with them. You can watch the original conversation. Here is the substance of what I covered, in my own words.

Why I Stopped Asking "What's Broken?"

When most people think about how the brain works, they reach for diagnostic labels. They want to know which bucket their problem fits into. I find that frame less useful, especially if your goal is peak performance rather than disease management.

The better question is where your resources bottleneck. Even high performers have afternoons that burn out, nights of bad sleep, days when creativity and flexibility drop off after a long flight or a short night. Those are resource problems, not character problems. QEEG brain mapping lets me find where the bottleneck sits, and neurofeedback can help ease it.

What Is EEG, and What Makes It "Quantitative"?

EEG is brain waves. Your cortex folds into sulci and gyri to pack more surface area against the skull, and the cells sit in columns at right angles to the scalp. That geometry lets us read their electrical activity from outside the head. You do not need a bald scalp. Those of us without hair actually produce noisier signals, because hair helps keep the scalp soft and the contact stable.

There are a few ways to use EEG:

  • Ongoing EEG is the raw, continuous activity happening all the time.
  • Event-related potentials (ERPs) are small evoked blips that track attention resources, used mostly in research.
  • Quantitative EEG (QEEG) takes a baseline recording and compares it against a normative database of several thousand people your age.

The word "quantitative" refers to the analysis, not the recording. We are asking how unusual your brain looks compared to everyone else at your age. Once we know where the statistically unusual features are, we ask what those patterns tend to mean at a population level, then look at whether that meaning matters for your goals.

Two facts about these databases. They are large and stable. And you do not change much relative to other people year over year. Map you today and again in a year, and the two maps look nearly identical, unless you did something significant to your brain in between: a serious meditation practice, neurofeedback, a head injury.

Why a Brain Map Is a Hypothesis, Not a Diagnosis

Because we compare you against a population, the patterns are valid at the population level and may not hold for you individually. A QEEG is a hypothesis generator and a prognostic tool. I use it to find candidate bottlenecks, then I check whether those candidates explain anything you actually experience.

Where Did Neurofeedback Come From?

The field grew out of sleep science, which is why so much of the language is borrowed from sleep research. In the late 1960s, an EEG scientist named Barry Sterman was at UCLA when NASA brought him a problem: astronauts breathing rocket fuel vapors, methyl hydrazine, were getting sick, and NASA wanted to know how dangerous the exposure was.

Sterman ran an exposure study with cats. Most showed a clean dose-dependent curve, where more exposure meant more symptoms, building toward seizures. A subset required more exposure before showing any instability. Those cats were seizure resistant, and he could not explain why, until he remembered that those same cats had earlier been in a different experiment. He had used operant conditioning, the same logic as Skinner shaping a pigeon's behavior, to teach the cats to raise a specific brain rhythm in exchange for a reward. Months later, that trained rhythm had left them resistant to chemically induced seizures (Sterman et al., 1969).

Sterman's lab manager had uncontrolled epilepsy. She was having frequent tonic-clonic seizures on heavy anticonvulsants that were not working. She asked him to build her the same machine. Over several years of training she came off her medications and stayed seizure free for an extended period (Sterman & Friar, 1972). Later, Sterman's review of the sensorimotor rhythm work reported that most subjects across the published studies dropped their seizures substantially, with a subset achieving full control over long follow-up (Sterman, 2000). In my own observation of people training for epilepsy, I usually see seizures largely reduced over about three or four months.

From there the work spread. Because EEG researchers already understood sleep deeply, they found the same techniques that reduced seizures also improved sleep onset, sleep maintenance, and sleep architecture. The reliable, low-hanging fruit today is sleep, anxiety, and ADHD. Most people can substantially reduce ADHD symptoms with roughly 40 sessions over three or four months.

Why Does Neurofeedback Work?

Your brain is already changing all the time. The question is how you would like to direct that change.

Neurons that fire together wire together. If you practice a firing pattern, the circuit reorganizes. Send someone to a piano lesson today and by evening the hand-related representations in their motor cortex have shifted (Pascual-Leone et al., 1995). That kind of rewiring happens fast. Building genuinely new circuits takes longer. So the brain runs on a short-to-weeks timescale of change, and learning is that change in action. This is well-established neuroplasticity.

People often ask whether neurofeedback improves the mind or the brain. As a cognitive neuroscientist, I do not find that division meaningful. The mind is the part of the brain you happen to be aware of, and most of what the brain does runs below awareness. Some things are primarily physiological. You will never talk-therapy your way out of the novelty-seeking, high-stimulus ADHD brain, though you can build behavioral scaffolding around it. Other things, like anxiety and trauma, often start as psychological patterns that then drive physiological change. Once the brain has learned a pattern, the physiological-versus-psychological split stops being useful.

What Does a QEEG Actually Measure?

We place a cap with about 21 sensors: 19 channels plus two ear clips. That number comes straight from sleep research, which is why 19-channel databases are the standard for comparison. We could get more. At higher electrode counts the spatial precision of EEG improves. For most brain-training work that is overkill, so we read the 19 channels against the reference database, adjusting for your age along a regression line through the data.

My late mentor in this field, Jack Johnstone, co-authored a strong review of the commercial databases, their sizes, and their strengths and weaknesses (Johnstone et al., 2005). Jack talked about endophenotypes, which is essentially what we now call biomarkers. These are sub-components below the level of a diagnostic label, patterns that recur across people and represent resource differences inside you. I care about the resource, not the label sitting on top of it.

The Markers I Read

Theta/beta ratio. A single ratio at the vertex of the head is among the most studied EEG markers for executive function and was the basis for the first FDA-cleared EEG aid for ADHD assessment. It separates many ADHD from non-ADHD brains, though its accuracy varies across samples (Snyder et al., 2008; Arns et al., 2013). In older adults with memory complaints, an elevated theta/beta ratio has been associated with cognitive decline. The ratio is a useful sorting marker, not a diagnosis.

Peak alpha frequency. Alpha speeds up into early adulthood as your neurons finish myelinating, then slows in later life. When you sit well below your age peers, your processing speed has dropped enough that word-finding and pulling items from memory get hard. Peak alpha frequency tracks cognitive and processing speed (Klimesch, 1999). That is a speed-of-processing problem, not a memory-storage problem.

Eyes-open slow frequencies. Your visual system idles in alpha with eyes closed. Open your eyes and that alpha should suppress and give way to beta. If alpha stays parked with your eyes open, I read inattention. Excess frontal theta with eyes open, in the dopamine-driven frontal cortex, reads as an ADHD-type pattern. I will not hand you a label. I will say "high theta state, so the pattern leans impulsive and novelty-seeking," then ask whether that works for you or gets in your way. Your answer sets how aggressively we go after it.

Connectivity. Bang your head and connectivity changes. You break tracks and pick up subtle inflammation, and that shows up reliably. We compare against injury-specific databases to gauge whether the pattern fits an injury or fits something else, like sleep deprivation.

Hot spots. Certain frequencies parked over certain cortex point to specific resource problems. Beta over the frontal midline tracks with OCD. Beta over the rear midline tracks with PTSD. Excess beta through the middle usually means over-arousal: trouble settling for sleep, pain, a brain that will not down-regulate.

What Brain Maps Reveal About Mood and Medication

Richie Davidson, one of the major figures linking mood and EEG, showed that frontal alpha asymmetry is a marker associated with depression. Normally the left frontal cortex drives an approach-oriented, optimistic, glass-half-full stance. When the right becomes relatively more active than the left, the pattern shifts toward an avoidant, glass-half-empty stance (Davidson, 1992; Henriques & Davidson, 1991). Across many papers this holds at the population level.

Brain maps can also signal whether medications are likely to work before the person feels it. One of my dissertation committee chairs, Andy Leuchter, found that early EEG changes within the first week or so of starting an antidepressant can predict later response (Leuchter et al., 2002; Cook et al., 2002). The average person cycles through several antidepressants before finding one that fits. Reading the brain early may shorten that search.

Case Examples From the Maps

A man in his late twenties came in extremely impulsive, with a cutting comment ready before you finished your sentence, abusing substances, unable to hold a job or friendships. His map showed excess theta (an ADHD-type pattern), a frontal beta hot spot (an OCD-type pattern), and the asymmetry pattern associated with depression. After about 30 sessions of neurofeedback, the OCD and depression markers cleared on the map. He still felt a touch of ADHD, but it no longer interfered with his work or relationships. A year later the gains held. This is a single composite observation, not a clinical claim about what neurofeedback will do for any one person.

Another client could not sleep because he had spent roughly 25 years drinking more than a bottle of wine plus a sedative every night. He did not crave alcohol. He was trying to use less of it, but without it his brain could not fall asleep. After years of heavy drinking, chronic alcohol exposure suppresses the brain's own GABA signaling. His first map, taken the day he left a 45-day medically supervised detox and completely sober, showed high beta everywhere, the signature of a brain that could not down-regulate. After three months of training, he was lying down on my office couch to fall asleep just to prove he could. A year later it held.

What Neurofeedback Actually Does

We measure your brain rhythms moment to moment, and whenever they shift in the direction we want, we reward the brain with audio and video feedback. Think Skinner's pigeons, not Pavlov's dog. We take patterns that already exist and shape them up or down, then watch whether your resources improve.

We can train EEG rhythms, or we can train blood flow through hemoencephalography for migraines, executive function, and social processing. Unlike body-based biofeedback such as heart rate variability, neurofeedback is almost entirely involuntary. You cannot feel the small rewarded shifts. You watch a screen, a simple game runs a little better when your brain does the right thing and stutters when it does not, and over time the brain updates its regulation.

Nearly all of this is non-invasive. There is a role for micro-stimulation, but the large majority of neurofeedback does not zap anything, and it does not need to. A typical course is about 40 sessions over three months, three times a week. That is usually enough to make real progress on ADHD, anxiety, and sleep for many people, and to make a dent in larger problems like seizures and depression.

Where the Evidence Is Strongest

The research base is large but uneven: thousands of papers, many with small samples and weak controls. There are structural reasons. Change takes months, EEG is hard to blind, and nobody owns neurofeedback, so there is no company willing to fund the multimillion-dollar trials. Field results often outrun the published literature. With that caveat, here is where I find the evidence most convincing:

  • Addiction. Alpha-theta protocols have been associated with improved abstinence rates in alcohol dependence in early controlled work (Peniston & Kulkosky, 1989).
  • Alpha-theta training holds you in a hypnagogic state, halfway between waking and sleep. The insight and creativity that usually bubble up just before you fall asleep, and then vanish, can be accessed and held there.
  • OCD. CBT with exposure is the standard, but a substantial share of people drop out because exposure work is hard. Neurofeedback is being explored as an alternative route.
  • Depression. Many small studies, plus some better ones, with follow-up data suggesting durability for some people.
  • PTSD and performance. Alpha-theta work shows both symptom reduction and creativity gains in performance studies (Egner & Gruzelier, 2003). Through the Homecoming for Veterans program, we provide free training to veterans at our centers.

Meta-analytic work on ADHD neurofeedback reports effects with stability at follow-up for standard protocols (Arns et al., 2009; Van Doren et al., 2019).

Questions I Get Asked

Can you boost delta for deep sleep? Yes. If the map shows too little delta we work to raise it; too much, we lower it. The approach spans a wide age range.

Can this reverse Alzheimer's? Once Alzheimer's is established, there is too much tissue damage in the medial temporal lobe to expect benefit from training. The better path is the metabolic work, addressing the panel of markers that, when several fall out of range, are associated with progression toward dementia. Bringing those back into range is where the more promising work sits.

How do brain maps correlate with neurotransmitter levels? Very weakly. Absolute neurotransmitter levels are nearly meaningless from the scalp. The simple chemical imbalance story was more a marketing frame than a validated hypothesis. What matters is range. In Parkinson's, motor symptoms appear only after a large fraction of dopamine neurons are lost. You may see theta waves alongside low dopamine, but it is a coarse, indirect signal.

The Working Principle

I run Peak Brain like a fitness center, not a doctor's office. I ask what you want, then I read your map for the bottleneck that stands between you and that goal, and we train the circuit until the bottleneck eases. If you are deciding whether this fits your situation, start by getting an actual QEEG brain map read against your goals, then build a 40-session plan around the one or two markers that explain the most about your day.

References

  1. Sterman (1972). Suppression of seizures in an epileptic following sensorimotor EEG feedback training. doi:10.1016/0013-4694(72)90028-4
  2. Sterman (2000). Basic Concepts and Clinical Findings in the Treatment of Seizure Disorders with EEG Operant Conditioning. doi:10.1177/155005940003100111
  3. Pascual-Leone (1995). The role of reading activity on the modulation of motor cortical outputs to the reading hand in Braille readers. doi:10.1002/ana.410380611
  4. Johnstone (2005). Clinical Database Development: Characterization of EEG Phenotypes. doi:10.1177/155005940503600209
  5. Klimesch (1999). EEG alpha and theta oscillations reflect cognitive and memory performance: a review and analysis. doi:10.1016/s0165-0173(98)00056-3
  6. Davidson (1991). Left frontal hypoactivation in depression. doi:10.1037/0021-843x.100.4.535
  7. Leuchter (2002). Early changes in prefrontal activity characterize clinical responders to antidepressants. doi:10.1016/S0893-133X(02)00294-4
  8. Peniston (1989). Alpha-theta brainwave training and beta-endorphin levels in alcoholics. doi:10.1111/j.1530-0277.1989.tb00325.x
  9. Egner (2003). Ecological validity of neurofeedback: modulation of slow wave EEG enhances musical performance. doi:10.1097/00001756-200307010-00006
  10. Arns (2019). Sustained effects of neurofeedback in ADHD: a systematic review and meta-analysis. doi:10.1007/s00787-018-1121-4
Full Transcript
[Music] foreign so i'll ask again how are your brains today your brains are awesome that's great they could be better just saying so um we're gonna talk about brain mapping something called qeg and also neurofeedback which is a form of biofeedback on the brain um when thinking about how your brain functions or how anything functions in your mind or your brain there's a tendency to pathologize to say oh this is broken or to come at the problem as if you're trying to identify the the pathologies and to a large extent we tend to focus on uh diagnostic labels going after what the actual bucket is that our problem fits into and i find that less useful especially in a biohacking context or a peak performance context to think about what's wrong with you it's more like oh where are the bottlenecks in resources even the most highly performant of us we'll have days when our afternoons are burnt out we don't sleep as well we aren't as creative aren't as flexible when we fly across the ocean or sleep deprived things like that so let's get into some of the tech and i'll give you a little bit of a historical background and then talk about or show you some of the actual things we find in brains and how we would go about making a permanent change over time so first of all what is this stuff eeg largely it's brain waves so you have uh sulci and gyri little squiggles in your cortex that increase the surface area and all of the cells that are in columns at right angles to your skull can be picked up from outside the scalp and no you don't need to have a bald head to get an eeg actually those of us with bald heads produce really kind of crappy eegs it's hard to get good signals when you don't have hair protecting the scalp and keeping it soft as my technician johannes is discovering right now recording somebody upstairs so eeg is several things ongoing eeg millions trillions billions of things happening in your brain all the time you can also look at eeg from sort of a research perspective and you would do that by looking at what's called erp's little evoked events in the brain that are responding to usually attention resources and then we talk about something called quantitative eeg which is just an eeg recording baseline but then you take it and compare it to a normative database of several thousand people and basically see how weird you are compared to everyone else who's your age and once you know where the unusual parts of your brain are then the fun begins then you say oh this pattern often means at a population level x y or z and then try to figure out if this is a relevant bottleneck for you or performance goal for you so after you determine what the patterns are then you would change the brain using neurofeedback or central biofeedback so again eeg versus quantitative eg quantitative really refers to the analysis not the recording and it's this database comparison a couple things to say about that one is these databases are incredibly robust and also you don't change relative to other people all that much year after year after year our brain map on you today and in a year would be identical assuming you didn't do something to your brain that was significant like develop a really serious meditation practice do neurofeedback have a head injury something else to really change your brain again getting away from this idea of diagnostic labels the brain map comes up with because we compare you to a population it comes up with patterns that are sort of valid at a population level but may not be valid for you so again not diagnostic not top down more of a hypothesis generator or a prognostic test and so we will look at several things and try to figure out where the statistically unusual events are in your brain and then figure out if they mean something for you that is worth going after here's some examples the amplitude of your of different brain waves or connectivity of regions can show you things like how thick your skull is if you have brain injuries if you're asleep etc uh the theta beta ratio is among the most highly validated discriminant markers for things like executive function a single measure of the ratio of theta to beta brain waves the vertex of your head can sort blindly adhd and non-adhd brains i think 94 specificity huge for in terms of picking out certain things uh peak alpha frequency i can actually tell you if you're slower in your cognitive speed than other people your age and if it slows down a certain percentage i can tell if you're having trouble accessing memory or finding words that's a speed of processing thing not a memory thing by the way so uh let's back up a little bit because the field of qeg sort of followed the field of neurofeedback and eeg broadly is a sleep science historically and so a lot of the language we use the technology we use is sort of couched in sleep research terms before we were doing qegs though we're doing regular old eegs there's an eeg scientist named barry sturman he was at ucla in the late 60s and nasa went to sturman said look our astronauts are getting sick breathing in rocket fuel vapors methyl hydrazine please figure out how dangerous this stuff is and so sturman took a this is in the late 60s so animal research isn't quite done this way now so i'm going to tell you this story you know uh hold your groans but dr sturman took a plexiglas airtight cage put a beaker of rocket fuel in it put a cat in the cage closed the door and started a timer and he found that of the 30 cats or so most of them had a really perfect dose-dependent curve where increased minutes in the cage meant increased symptoms so rocket fuel makes you have seizures essentially over time and here's the data so the bottom solid line is the measurement of about 24 cats and this is actually a an adjusted slide it used to say vomiting vocalizing panting seizure coma death but they removed coma and death from the paper for some reason uh 24 out of 30 cats perfect dose dependent curve the other cats require two and a half times as much exposure to show any instability drooling stumbling and we're really seizure resistant and he couldn't figure out why until he remembered that six months prior he'd done another experiment uh seeing if he could get cash to raise a brain wave in response to a little chicken broth dropped into their mouth and they could operate conditioning so you can think skinner's pigeon shape a behavior that already exists and that was wonderful he put them back in the subject pool and months later these cats had seizure-resistant brains and refused to have seizures it turns out that dr sturman's lab manager was an epileptic uncontrolled epileptic i'll show you her data in a minute i think but over time the research assistant had her seizures controlled several other single case studies were successful and then over time sturman produced a paper in 2000 that showed 82 percent of subjects showed a more than 30 drop in seizures and 5 percent of people had complete reduction or control of seizures for over a year i typically see 95 sort of abolishment of seizures when i work with them usually in about three or four months they're just kind of gone and gone for good or dramatically reduced over time this is his lab manager's data and these are tens of seizures on this scale so when he first started tracking or she was tracking her seizures in 1970 she was having 30 40 50 seizures a month and if you know anything about epilepsy that's an awful lot of tonic clonic grand mal seizures that will kill you over time and she was on meberal tegratal dylan huge neuroleptics that were not controlling her seizures so she basically demanded he build her machine to do what they just did for the cats and he built her machine they played around with it and off over several years she trained and then she went off all of her meds right here and she remained seizure free where the blue line is for over a year complete cessation of seizures after having dozens a month for many many years so that was a pretty impressive thing and from there the the neurofeedback work spread out from epilepsy and again because eeg is a sleep domain initially we have lots of awareness of sleep if you're an eeg researcher and discovered the same techniques that can ameliorate seizures also improve sleep architecture sleep onset sleep maintenance sleep sensation reliably really reliably and then from there we moved into all these other domains at this point the low hanging fruit for neurofeedback are things like sleep anxiety and adhd something like 90 95 of people can eliminate adhd for good in three or four months of training 40 sessions or so can usually eliminate adhd permanently over time so it's a change it's happened slowly but once it's happened your brain has new resources and it tends to reinforce those resources and practice them just by living in your brain so why does it work mostly because the brain is already changing all the time it's not a question of if you're going to get changed it's more like how would you like to control the change you're going to get right so i'm sure most of you folks who are very savvy know that the brain tends to rewire itself so neurons that are touching they have a synapse between them get used to firing together when they fire in a chain over time so if you practice different firing patterns your brain actually changes over time in fact if i took one of you guys and sent you a piano lesson today a samino already played piano by the end of today every single hand cell would have moved around and talked to a different cell in the motor cortex of your brain every single cell so learning moving cells around rewiring happens on the order of minutes and then making new cells and building circuits out of novel cells takes about five weeks so you have a five minute to five weeks sort of time scale of change in the brain and many things support this but learning uh is a process of change uh is this a question of your mind improving or your brain improving um not really a valid question from at least from my perspective i'm a cognitive neuroscientist so for me it's all about how the brain produces the human experience and resources of executive function sleep stress mood substance abuse etc so i'm really thinking about the intersection of the tissue and the things the tissue is producing and from my perspective the mind is simply the part of the brain you're aware of hopefully and there's lots of things you aren't aware of the vast majority of what your brain is doing you're not aware of it all it's just things happening like you aren't really aware of your you know peristalsis motion and your gut moving some of you probably are but most of us aren't that aware of the deep internal things um some things in the brain are primarily neurological physiological you're not going to talk therapy your way out of adhd ever you might develop scaffolding behavioral tricks to minimize the impact on your life but you're never going to get rid of the sort of novelty seeking high stimulus adhd type of brain by doing talk therapy and other things as well you would never talk therapy your way out of but some things you can so anxiety often responds well talk therapy trauma responds pretty well but anxiety and trauma end up being a psychological if you will pattern that then produces physiological change so if the brain has learned to do it is it physiological or is it psychological again i don't think that division is all that meaningful ultimately all right so quantitative eeg how do we figure out what is going on inside your noggin first of all we'll put a full head cap on your head um we will then measure about 21 locations um that number comes from the sleep research old classic data you put 19 channels plus ear clips on the ears and this is why a 21 channel cap is the standard in the field um a big part of quantitative eeg is the database of comparison who are you comparing yourself to and because of sleep research the vast majority of reference population databases are 19 channel databases so while we could get more information off the scalp in fact if you go to 70 electrodes in the scalp the spatial precision of eeg is equivalent of that of fmri so you can do huge things with eeg but from a clinical perspective that's kind of like overkill we mostly look at the 19 channels in the scalp and compare them to the reference database the eeg is very stable day to day year to year maturation is the biggest change we reference your data to other people your age or to a mathematical sort of average brain at your age a regression line through the database on age and then plot you on that line essentially if you're interested in knowing more about quantitative eg my mentor in this field jack johnstone who died a couple years ago wrote a great paper in 2005 talking about the state of the databases the five or six commercial products how big they are what their strength and weaknesses are and jack talks a lot about this idea of endophenotypes uh which actually are kind of like biomarkers right jack published this paper before the word biomarker was all that in you know common use so the idea is that there's these sub components that aren't necessarily diagnostic labels or high level things you can talk about in psychology but that might be patterns that show up across people that will represent resource differences within you that can lead to either performance improvements or symptoms and we care about those resources not the label above them so to speak so again i mentioned some discriminants earlier here are some most reliable here the ones that we tend to look at in the brain when i look at your brain and for about a dozen of you we'll go over this next couple of days and then i'll probably go over it again with you next week on the phone or something but again theta beta ratio theta beta ratio is a huge marker for executive function in non-elders it's incredibly reliable for screening for adhd in elders it actually can predict progression to dementia or not if you have mild memory issues i'll show you some data on that in a minute we also look at eyes open slow frequencies most of us make a lot of slow frequencies when we close our eyes the visual system goes into alpha in the back of the head that's supposed to happen when you open your eyes that alpha suppressed replaced with beta a faster frequency well if you open your eyes and your visual system is stuck in alpha we would call that inattention if that's very bad we'd call that add if you make a lot of theta and the dopamine driven sort of frontal cortex with your eyes open we would call that adhd again my goal is not to get to the diagnostic label so i'm not going to say oh you have adhd i might go oh high theta state so you're pretty impulsive your pattern matching or novelty seeking does that work for you does it get in your way and how you answer that question tells us how aggressive we go after different resources so again we're not trying to make you normal or average we're trying to figure out where the bottlenecks are for your particular performance limits and goals and then ease those through neurofeedback other things that show up i mentioned alpha speed as a process as a function of processing speed alpha speeds up until at age 25 as your brain myelinates the neurons wraps the neurons of insulation and it slows down about 60 and older as you lose enough cell bodies to have a decreased speed of firing when you're more than a standard deviation slower than other people your age your speed of processing is slow enough you can't grab things out of your memory or word finding becomes a real hard time a hard problem for some people other things that show up uh we look at connectivity patterns when you receive wear and tear when you bang your head don't do that when you bang your head connectivity changes you break tracks you get subtle inflammation and that shows up really reliably typically we usually use databases of comparison for specific populations as well so you have a lot of injuries would compare you to an injured population and see if it seems plausible that you're experiencing symptoms from an injury versus symptoms from being sleep deprived or something uh let's see what else oh we also tend to look for certain we call this hot spottology where you look for certain cortical patterns and say oh the scalp is hot in this frequency above a cortex involved with x resource therefore maybe that's showing up as a dysregulated resource so a little hot spot of bait in the front midline is ocd on the back midline is ptsd if i see beta in the middle usually it's an over arousal sleep pain kind of a problem settling down i'll show you some of these data sets in a moment but essentially there's several papers showing that these subtyping the phenomenological sort of assessment if you will of these patterns is valid and reliable as long as you don't try to make everything reliable for every individual person so at a population level these patterns are pretty reliable also it turns out that the the changes in the mapping can tell you if medications are working uh one of my dissertation committee chairs dr andy lucter find that within a week after starting an antidepressant you can tell if it's going to work a month later because antidepressants take about three to five weeks to really work for most people the average person needs to go on three or four different antidepressants before you find one that really works well dr luchter can assess your brain and after initially it was 48 hours now he's cautious and says a week you can see the changes in the brain that tell you aha this is going to produce an antidepressant effect for you later and so that's in terms of managing symptoms that's huge because uh here in sweden the healthcare system is quite a bit better than in the u.s where i'm from but you know you you may end up with like two days in a psych hospital if you're depressed or your therapist may just throw drugs at you and not necessarily keep track of what's happening uh you know across your your scope of treatment so it's really important to have tools to go aha the brain is changing in a reliable way here's several papers that are several findings to talk about it's reliable for assessing mood richie davidson one of the big mood and eeg guys is also a long-term meditator showed that frontal asymmetry having left to right activation reversed is a really reliable marker for major depression typically we have a left front driver of the bus when the right becomes more active in the left you have a sort of avoid glass half empty negative kind of mindset when the left is driving the bus you have a approach active optimistic glass half full kind of mindset and so several papers hundreds of papers have found that there's a a soft reliability if you will again at the individual level doesn't track at a population level it's very valid so here is an example of what comes out of a qeg this is a population assessment so we're looking at standard deviations compared to a certain reference set so standard deviations with a population mean are called z-scores and in this case there's two different populations this is an nyu memory center study uh 40 27 37 40 40 4 people i can't do math so something like that walked into the nyu memory center with complaints of memory people who are mostly 65 to 75 and they said look i'm having memory issues and this was a longitudinal study track for between seven and nine years per person and they found they could pretty reliably sort those people who walked in with a memory complaint into two groups those who would decline into dementia and those who would not what that shows is the group that did not decline had pretty typical levels of brain waves and those that did decline as you can see had high levels of theta and low levels of beta so again a high theta beta ratio that's the same marker we use in kids and adults for adhd but in elders who have a memory problem it predicts progression into more memory problems again not suggesting that adhd leads to dementia but suggesting if you want to sort elders into those who will progress and those who won't the theta beta ratio is a pretty valid marker um these are called erps these are evoked potentials a little blip in your brain that happens when you experience something uh it's not terribly clear by several populations of people superimposed in the horizontal slide here as you go up in age it goes down in amplitude so you have fewer cells firing to really robust effective age on the right hand side we see the latency the timing as you go up in age the timing of the peak goes from dead center on this line to about a 50 milliseconds later in time so literally your reaction times slow down as you become older and lose cell bodies here's a qeg showing different types of adhd you can actually screen and say oh your add or your adhd pretty reliably extra theta is adhd extra alpha's add again very reliable metrics and several studies have shown you can sort this stuff into non-affected and affected populations purely on the data not using behavior tests not using interviews simply looking at brain activity you can sell oh you have some issues executive function wise or you don't why we look at executive function uh essentially from your perspective it's a no-brainer no pun intended but you know why you want more executive function you most of you guys are trying to really operate at your peak level so executive function to a large extent is a proxy for other resources in the brain there's no executive function region of the brain you have areas involved with supervisor retention with planning and execution with sensory integration all kinds of things coming together so high level executive function is a very robust and complex phenomena and therefore anything that undermines the resources shows a drop-off in those resources and attention if you will is the place that most people are aware of where their resources are quite soft when they are soft attention and anxiety especially so we often focus on this as a really tractable thing to both identify and go after for you here's another qeg brain waves on top show this person made a lot of delta and theta so they're pretty sleep deprived maybe adhd may be injured extra delta is an injury usually this person also has a little hot spot of beta on the front midline that's an ocd marker and the back of their brain was not relaxing this thing lit up in high beta that's a hyper vigilance kind of anxiety marker here's somebody else uh this guy had a mixed presentation so extra theta is adhd add ocd again he also had major depression with left front alpha and right front beta which is not what you want that's the same guy in the bottom after doing about 30 sessions of neurofeedback this is one of my clients and when i met him he was the most impulsive guy i've ever met and he was also really nasty he would slide a cutting comment in before he finished your sentence every single time he was brilliant but kind of an and no one liked him and he couldn't keep friends he couldn't keep a job he was also abusing substances he was pretty miserable at the bottom he still felt a little bit adhd but you couldn't see it anymore it didn't get in the way of his social and academic and employment sort of resources and no more ocd no more depression those complete sort of symptoms lifted 100 and remain stable i saw his mom this guy was 28 by the way i saw his mom about a year ago and uh he maintained all the gains was back working again it was working at a cannabis shop so his mom wasn't happy but you know i can't do it one thing at a time um here's somebody else uh this guy on the top was somebody who came in to see me because he wasn't sleeping and he wasn't sleeping because he was drinking a lot or had drank a lot he he was doing a bottle and a half of wine and at a van and an ambien every single night for about 25 years and when i met him you know he's a six foot five 300 pound bright orange gentleman from liver failure and he was an unusual alcoholic in that he didn't crave alcohol didn't want it was trying to minimize his use of it but he could not fall asleep without it after years of drinking the brain no longer knew how to produce gaba because the alcohol did it for the brain the absence of alcohol the brain just did not down regulate so you see these high beta and beta events when you have a lot of over arousal this is somebody's like a nervous shaky alcoholic who's burnt out interrupts themselves can't fall asleep really scattered and by the way the top slide the top uh assessment was taken the day he came out of a 45-day medical detox for alcohol he was completely sober and had been for a month and a half in the first map this is not an effect of the alcohol actively it's an effect of the damage if you will from the alcohol chronically so the bottom set of pictures is him after doing three months of training with us but about two weeks in he would come in and lie down on the couch in the office and go to sleep just to prove he could so and i saw him about a year after this and it was all stable and he maintained the gains as well so what is neurofeedback essentially we're measuring these patterns moment to moment and whenever they happen to shift in the right direction we applaud the brain with audio and visual feedback so you should think skinner's pigeons not pavlov's dog we aren't doing weird things and making you have weird behaviors we're taking things that already exist and shaping them up or shaping them down and seeing if it affects your resources so it's training eeg brain waves or heg hemo encephalography blood flow which you do for migraines for executive function for social function unlike body based biofeedback hrb gsr neurofeedback is almost entirely involuntary you can't feel the little resources that are being rewarded so you sit there and watch a computer screen and the the game let's say runs a little bit better when your brain does the right thing runs a bit worse when everyone knows the wrong thing and over time that teaches your brain to change its regulatory uh domains um i think what time for questions right at the end so if you hold that for a second uh neurofeedback almost never zaps the brain you can do micro stimulation there's there are roles for it but the vast majority of neurofib does not do that and it's not necessary to do anything active to zap the brain most people tend to have a three-month course of training and get permanent effects with about 30 sessions or more i do 40 in three months typically for my clients three times a week and that's enough training to knock away adhd anxiety sleep issues for almost everyone and to make a really big dent in bigger things like seizures depression etc and again i'm using diagnostic language just because we know what these things mean we know what the word depression anxiety adhd mean i'm not concerned about getting the diagnosis to go away i'm concerned about meeting your needs so unlike everyone else in the field peak brain approaches this work like it's a fitness center not like it's a doctor's office for a psychological you know perspective so we're never gonna ask you what you we're always gonna ask you what you need never gonna tell you what you sorry we're always gonna see what you want never tell you what you need that's what i meant to say um we've already talked about this the brain is very plastic and tends to rewire here are the domains in which there is very good evidence for neurofeedback and i've given you a link to the comprehensive bibliography that essentially categorizes thousands of papers by complaint and gives you all the different research what you'll find if you follow this link is there are thousands of papers that have small ends that have weak controls and so the field has been left really in the couple decades behind in the research in terms of what we can do in the clinics there's many reasons for that one is it takes many months to make change two it's hard to blind eeg and three nobody owns neurofeedback so who's gonna pay the three to five million dollar study costs if you can't get that money back so the clinical efficacy far outstrips what you'll see in the research here's an example of a neurofeedback screen anyone who's coming on monday will see this in action and practice with it but essentially pulling raw brain waves into the white squiggle the right trace in the screen and then filtering out frequencies you may want to measure this person had three wires on their head two ear clips and one wire right here and then we're measuring different brain waves moment to moment the bottom left and whenever those brain waves all happen to shift in the right direction a game runs better on this game we have a little spaceship flying through a tube it's very basic game and sort of techno music climbing in volume and brings the right thing and dropping in volume and it's not and the spaceship stutters it goes faster or slower based on what's happening in your brain so um i've got several studies but not a lot of time so i'm going to show you there is some research and you can dig into this yourself if you're interested many studies in adhd i mean many studies in adhd many many studies in seizure disorder i gave you the sturman link which is a metadata paper you can pursue that huge number of studies on addiction in general the research shows the recidivism rate for alcohol relapse which is about two thirds to three quarters depending on where you look gets completely reversed after neurofeedback so it drops to one third or one quarter depending which study you look at so it's a very robust effect this is most using alpha theta training which as peak performers you guys are going to want to know about alpha theta training puts you in a hypnogic state halfway between awakened sleep and it holds you there so all that good idea you had when you fell asleep last night or the night before when you solved world hunger or you know cured cancer had the best sci-fi novel plot idea and then you fell asleep and we were robbed of that beautiful creativity you had we can hold you in that state ideas emotions thoughts insight bubbles up for you reliably depression a lot of small studies again but some really good studies that show one in five-year stability on follow-up uh ocd uh 51 efficacious is the standard for cbt therapy for those people that stay in cbt cognitive behavioral therapy over half of people drop out of cbt because it's painful to do it's stressful for those who stay in it with ocd it's the most effective treatment neurofeedback without exposing you to things has better efficacy than cbd and then we actually get scores in intelligence i'm sure you guys know who dave asprey is dave asprey tends to tout this study which is you know it's a study it's pretty good but honestly intelligence is not a very robust phenomena intelligence is what intelligence tests measure so it's very circular what you probably care about are things like inhibitory control working memory and other sub-resources underneath the complex thing called intelligence we also have again more alpha theta really profound work on ptsd i should mention that peak brain participates in a program called the homecoming for veterans where we provide a free chair in all of our centers for a veteran for free training so let us know if you're in the u.s certainly but we'll also be in malmo uh peak really in melmo in a couple months we're opening up i think in july or august so if you're interested in copenhagen or malmo services let me know and we will uh get you up and running down there and here's several studies again in alpha theta that show not only can you fix problems like alcoholism or ptsd but really dramatic performance improvements in creativity we tend to see permanent change in about 40 sessions and i've also given you a link to a recent metadata study that shows at least six months of stability after neurofeedback with adhd and then if you want more information some more resources here you go so thank you so much for listening uh is there anything i can answer for you this time yes very impressive um on a different topic can tg and neurofeedback stimulate delta waves in a method in terms of getting better slow wave sleep yeah absolutely yeah but if you don't make enough delta we can boost it if you make too much we can reduce it either way absolutely yeah okay very easy to do and you would bring it to an age level or just to get there uh if you have a brain it works so it you know i work with four-year-olds up to people above 100. i'm also a gerontologist ucla so i tend to do a lot of work with elders 65 and up but i also work with children quite effectively and i have a lot of autism experience so the other end of the age spectrum so sir um you mentioned 20 slides earlier can you move it back sure a very very beautiful slide for me uh there was a brain map a map of a brain connection maybe you measured brain activity uh what device do you use uh to record well yeah yeah for this infographic yeah um there's several devices out there um any 19 channel recorder can do it we're using the neurofield q20 device which is the cheapest on the planet right now for a good robust five thousand dollar amp that's the cheapest out there but uh and the second question can this approach reverse cognitive disabilities and alzheimer's if you have alzheimer's you have too much tissue damage in the media temporal lobe to receive benefits i would direct somebody to the recode or the the brazilian program to do the 35 metabolic markers resetting showed that if you have seven to nine of those markers out of range you've progressed to dementia if you correct them people like fifteen percent of their hippocampus left completely regrow the hippocampus symptoms go away they go back to work okay thank you low to correlate what's correlation between brain maps and neurotransmitter levels very very low here's the thing guys neurotransmitter levels are almost meaningless as an absolute doesn't matter there's no such thing as a chemical imbalance in your brain doesn't exist that's a marketing strategy of drug companies there's no validity to the chemical imbalance hypothesis of mental illness doesn't exist so if you have a range of neurotransmitters that's what you care about you stop ranging illness and death happens parkinson's happens when you lose 75 of your dopamine neurons no symptoms below that it doesn't matter how much you have of these things it's a very coarse indirect measure of dopamine and things you see theta waves with low dopamine but it's very coarse so any final questions guys thanks so much for listening i really appreciate your time thank you [Music] you
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