NeuroNoodle Live Q&A | Neurofeedback & Mental Health | You Drive the Content – Ask, We Answer

uh exactly we're we're we're talking about how to uh uh best practices of Q q&as re relying on the audience to drive content is is a lot rougher than yeah live streams I think are also not promoted or shared the same way that non-li stream content is by YouTube De prioritize to touch so what I find is um what I'm being advised anyways by people that watch my stuff is like you really should be cutting these things up because the static ones that are posted will generate much more uh push from YouTube than the live ones even even after the fact you know they're not necessarily high volume so I'm three shows in of cutting these up because the questions that are asked and you know the answer you know put it out there y it's just oh man it's a lot of work I need money I need money yeah yeah I'm I'm learning through all that stuff you know when you're when you're a oneman shoing somewhere you got to kind of be good at it all right so good ideas and then the show needs to something needs to go up that's right that's right that's why that's why there's articles in you every week for the biohacking thing it's starting to get a little bit like okay well today I'm gonna do like my top five opinions on this you know writing a whole article so well hopefully everybody's recovering from the election uh you know everybody's in trauma give it 24 hours and then you know like life goes on but I am kind of curious about that uh senator in uh Pennsylvania with the stroke and using the close captions and I fedman yeah fedman fed yeah I I'm like was he like getting fed the information or he really needed that to connect the dots because of the stroke I don't understand what was going on anybody got a clue yeah that was inasia uh probably um it looked like uh receptive language probably auditory Aphasia auditory driven there's the Anthony you can you can help me understand if my Neuroscience is Rusty but I'm believing it's somewhere in the superior temporal gyrus um leading into Vern's area so auditory inputs from basic primary tissue uh my hunch is he blew blew it out on the left and he didn't have receptive language that was all that complete heading into the veric tissue so he couldn't Out imagine being in a room full of people speaking to each other in a cocktail party and they're all speaking really loud there's lots of jumbled conversations you might get the information in but it's really degraded and that can happen with those uh assuming he had a mid-temporal or posterior temporal stroke he could have that kind of phenomena going on um and then you could reroute you can use the V visual tissue the superior uh fusiform gyrus um and sometimes I I I when this happened I looked it up to figure out if he was left-handed and I couldn't figure it out because he always holds the mic in his right hand but I couldn't see any some politician couldn't find one picture of him signing anything uh but if he I I he may have been recruiting the right um auditory tissue to bypass and then routing it through back into the front left you can do that or you can hit the visual tissue instead and then route that back into vernes and bypass it by Imaging because seeing a word anchors meaning and it does it better and faster than hearing a word it's it's a much more direct route into language than hearing it actually so less expensive anyways that that I think he was doing that he was using Vision to reroute and then he might have been using controlateral hemisphere well kind of where you know I'm trying to get out of my political mind uh because you know you get so ramped up going into it but you have some somebody in political office that has that can they can they function because they had to pause the interview because the Clos captions W weren't working so I I I mean at that point he was dealing with more right and that was I think that was somewhat Rec uh uh somewhat soon after the injury or the stroke yeah yeah um and he initially had more trouble than that I'm sure he had compound or mixed easia before that where he couldn't understand or read or speak or anything and even and you saw him recover his his his fluidity of language over several his first couple of conversations of him coming back and speaking to a reporter were really painful yeah he was he was sort of memorizing lines and not fully like embodying the words he was using it was clear he was you know stumbling through the production of language and then he got better at production but still had a receptive issue and now you see him answer questions that are a driven so it's not necessarily a static thing um but I would say it's about equivalent to would we would we consider deafness a um a disqualifying disability for leadership in public office because it's sort of at that level if you can work around it with an accommodative device a teletype or you know it's sort of at that level for him he's not really M lacking language just my take my take is like you go to a foreign country you have an interpreter so I being deaf okay I get the close what I was what I was concerned about is he could hear things he was looking at them but he couldn't connect the dots and that's kind of where I was like wait a minute should he I don't want to put down a guy that's got a stroke but this is somebody that's in a swing state that could you know yeah the fact that he could do it visually proves that there was no cognitive or true language issue it proves that that he didn't have an abolishment if you will of concepts of language or concepts within language so it's just a it's almost literally like a hearing loss except it's more about the meaning of of words probably more than anything else are weird well at Bruce Willis right does he have he has some Aphasia as well that's what he and he could production easia more more more brokas more front yeah yeah and they said that his stutter was masking it from his uh wife at least or something like that he has frontal temporal dementia right FTD so it's a it's a neurovascular degeneration in the anterior frontal anterior temporal and then frontal loes and that's right where brokos is on the left the production area right so what but they never said he had a stroke so that's what I'm trying to understand but the the key word is aasia and you have Aphasia you have to have a stroke or disruption well no just just the tissue degrading okay like you know frontal Temple dementia FTD is a a loss of tissue in the in the lateralized frontal loes so you're you're you're losing tissue if if it was medial temporal that's more Alzheimer's that's more memory formation and memory retrieval at some it's retrieval first but if it's more anterior you get impulse control you get language if it's right hem right front you get really negative nasty angry moods if it's it's anterior poles that degrade you get hypersexuality you know you can get of localized uh tissue to describe the phenomena you're seeing this is the core of neuropsychology that closely aligned field that we that we we sort of hang out in the shadow of doing diagn like like like prognostic work on phenotypes we're kind of doing the the neuros thing of trying to localize the resource or figure out what that thing is from mystical data that is you know patterns in in testing so Anthony what's been going on man I I saw your emails I see your post and like I said I've been in political mode you know all week and you know I'm trying to decompress take take my mind off of things I don't know I guess there's this one I sent to Jay that um well a a 2020 review says that changes in diagnostic criteria have accompanied a 20-fold increase in the prevalence of autism spectrum disorders over the last 30 years uh and so you know Jay's response was and I think something in that paper was um they're alleging that uh there's over diagnosis autism because they're confusing other conditions potentially as autism and you know Jay's Jay's response was just um the ASD diagnosis or the diagnosis tool is invalid in the first place and so he said you that's why we need neuro image yeah but we've been hearing that the diagnosis rates are increasing like that we've been hearing that for 30 years like I I I started working in autism 25 or 30 years ago and I've been hearing since then that autism rates are skyrocketing oh it's the diagnostic criteria and they keep going up and the diagnostic criteria are not continually loosening to create a bigger bucket we are actually getting something happening it's just not a clear signal against that phenomena so I've been hearing that same thing for 30 years I like that so well you know I came across and Jay can chime in too but uh so obesity parental obesity actually greatly increases the risk of autism and anywhere from 2 to 4X in the studies I have and the you know that's been increasing all along for for 30 years I guess since the 80s so it's it's parallel um so older fathers especially yeah factor and we are having later later child later parents that's that's a trend since the 60s I've heard that maybe a piece of it we don't know right we we we're still really neophytes and deeply understanding the brain we we're phenomenological lists so I think the granularity of the diagnosis historically may have been uh had to be more severely deviant to be called um but uh you know regardless of the rate of the diagnosis if the diagnosis doesn't predict treatment is just categorization and the the diagnosis they admit is a spectrum what the hell is that well there's a lot of different things you know they don't know what it is uh it's a giant catchall and there's some uh subtle uh genetic things that end up in that same bucket that they're now differentiating um odd uh genetic variants uh that end up having uh negative cognitive impacts uh uh the incidents of epileptiform content for God's sakes 70% you know so uh yeah it's is that changing Jay is that do you have a perspective on on epilepsy and instability EV the brain over the past 50 years do we see a an increased uh disregulation of our population of Developmental and non-developmental people because you've seen more eegs than anyone I know and maybe anyone anyone knows um in fact it's predictive of the psychiatric presentations quite often with no history of seizure uh but you can see the the you know temporal Lo discharges and their events of outof control rage you know and and they're they're linked and if you give them an anticonvulsant you get a positive clinical outcome Ron swen's group that we uh we saw epileptor content these are psychiatric patients including some on the Spectrum but they're they're all in there as psych patients not for epilepsy and they don't have a history of epilepsy but they had discharges in their EG we recommended an anticonvulsant be considered and they actually followed through and and gave that 85% % clinical positive change you know that they get better uh when you actually treat the eope from content with an anticonvulsant and you know in traditional neurology they would not treat them because they're no seizures but the end up with antis psychotics and neuroleptics used for an anti psychotics behavioral control it makes it worse but but even even our letics major TR izers which are seizure controlling were used historically for disregulated behavior of any sort to some extent right if your behavior if you were disregulated enough you got Dilantin integral and mball and you know you got drugged up to the gills if your behavior was not controllable and it wasn't you know yeah chlorpromazine equivalents so I'm wondering back back to the question though we have an increased incidence of autism spectrum disorders we have an increased incidence of ADHD we've increased instance dramatically of sleep issues in the past 30 40 years does that mean that as a population the bucket's bigger so we must have more epileptiform problems that are floating across the EG landscape but is it growing in a population percentage are we just regulating as a people with the microplastics and the head concussions and all the you know like the all the crappy Behavior and the processed foods and the seed oils are we is that part of the problem the the people that make it into a normative database before their EEG is looked at still have a 3 to 5% small chance of having a discharge and those individual background rate that's the typical rate that's the typical background rate 3 to 5% now anxiety has a 12% incidence and you think well 12% that's not much well it's 400% above the background you know so uh you it's significant and and if you have Panic it's 3% not 12% so the the the number of epileptor discharges you see ends up changing kind of how you present clinically as well so you know and this is true AC cross label like right so we have this in the neuro atypical broad landscape we have it autism ADHD bipolar trans trans diagnostic marker what between 20 and up to 50% or something right depending on the I've listen to your talks there in the meta analysis for autism was gigantic and again that one study had over a thousand people in it and they did 24-hour EEG and they had an 85% incidents you know but they did 24 hours I want throw in a curve ball a bit fellas okay I want to throw in a curveball if everybody can hear me can you hear me first hey Dr Mar welcome CER working thanks for oh gosh yeah um no it's just you know one of the things I'm I'm growing more and more concerned about is what is typical what is not typical what is normal what is normative you know we can play around with the terms but one of my fears in general is that the natural variation in persons or the acceptable natural variation in persons in in our medical or psychiatric or psychological differences is getting narrower as you know very ironically as a populace where where we're going all pro- diversity um and I think we have to kind of look at these type of things you know in terms of you know ADHD is a real classic you know J how many kids when you were in school you know had the symptoms of ADHD and were considered a major problem in school how many how many of those folks did not go on to you know I'm going to air quote here successful lives you know how much of this is about classroom management versus betterment of persons and helping persons succeed more in school um not to throw in the loop about you know the the the finances here Canada is a really good example if you get that diagnosis of autism within certain age rages you can get up to $20,000 um you know for different forms of therapy and and Aid so there there's so many different layers here U but my concern again is you know Direction versus correction you know what all of us in our profession we know you know in terms of Neurotherapy we can take folks who really really having various troubles be they Scholastic or mood or what or or or sleep or what have you um and help them but we can also take folks that are kind of okay and put them in the Peak Performance but just because we can improve does that necessarily mean there was something wrong uh and I and and for this uh I I really underline with children you know the various paces and styles of learning does that me necessarily mean something is wrong same thing with adolescents I don't know of anybody pre um you know the the generations now who didn't have a stage of angst um in adolescence um and most of us did not get the label of anxiety of depression it was a stage and phase of adolescence as we figured out our place in the world now I do not mean to undermine any of this but I think it's really really important that we not over or under magnify things I just wanted to kind of put that out there met with silence uh oh I I really avoid the um the DSM categorization because I'm not a doag ician or a therapist in that in that role more more scientist and educator so I I think about it in terms of goals and suffering dis regulations in the data so it's kind of like hey here's some unusualness in the data difference not yeah problematic people are weird good job be weird the goal is not to move you to the middle of a bell curve the goal is to use things that stick out and test ideas here's what's plausible or often true across a population that to see if they jive with your uh goals or suffering and if they do well then great then you have some low and fruit turn the the the the street light on look for the keys right under the light you happen to have if there obvious stuff take care of it it's regulatory if it fits your goals or suffering yeah you can then help people with this real serious transformation without pathologizing it and it's you know often works well that way I will say I you know part of my job today I was talking to some parent and and their and their kid and I literally had a conversation about was this an appropriate or disregulated amount of Ang is this a normal teenage 14-year-old angst or are we seeing something that's you know so I frame stuff like that because parents are like is this normal and I talked to so many parents I'm like yeah that's totally yeah that sounds pretty typical you're you're you're mental issues is having hormones yeah that's totally y uhhuh cool that's that sounds just fine wait what is normal exactly well exactly that's my whole point as typical versus normal is super important in my book where you say DSM P just look it up in the DSM P to push J's buttons even further you know um Mo many of us um in the quote unquote professions that supposedly do or can diagnose um have been anti- DSM for a very very long time um but kind of you know swimming Upstream in terms of everything that's being pushed down in terms of our education but many individuals you know and they hit the floor and are actually in practice kind of go whoa hey wait a minute you know what what purpose is this serving and and again preaching to the choir completely you know the same quote unquote symptom sets match so many supposed titles it's just a matter which one you pick out and you want to match up so I think we're all in agreement here you know get fashionable certain diagnoses become oh good God yeah yeah yeah yeah yeah it's so it's so obvious when you're looking at the EG qeg kind of where targeting is uh in in brain function and dysfunction and in Psychiatry using TMS with this gigantic 1.5 to3 Tesla magnet they're using the DSM of depression or OCD to Target and to train and they don't look at the EG underlying it now some do some do but it's not normal I mean the the psychiatrist a psychiatrist that has the machine and gets attch to operate the machine and they can find the spot that makes the fingers wiggle and uh they can go forward from that and find the spot to treat depression it's hard though for them to choose to do something off label I mean I have psychiatrists that use the queue to learn about brains of their clients they make sure they're in in the ballpark but they use it not to sort of then Target the TMS because now they're operating in kind of No Man's Land instead they use it to sort of screen inter people that are the common good recipients for the saint protocol let's say and um it's it's about they they're very constrained by what has already been demonstrated as best practice use of these tools in some way and I think it's probably good because these tools are really they can be somewhat aggressive pushing although although the TMS protocol is patented the combination of uh pointing the TMS magnet at a thalamocortical d rythmia and trading the person with the psychoactive drug like a camine or psilocybin Andor Andor and or there's a big long list that combination without any DSM at all look at look for theam cortical or rythmia treat them with the drug and and hit the location with the TMS and uh that that's a patented protocol so uh uh that it there are people that actually look at the EG and use it for guidance and the most extreme case of that is this group that uses it without the DSM at all just to TSM TMS targeting based on thalamocortical dis rythmia man if Dr sterman only going in terms of patenting a process it's yeah well a lot of businesses a lot of businesses do that though well then you can then you can invest money into doing research around it and charge money using it and we end up with an infrastructure around it part of the problem with neuro feedback is that nobody owns it sufficiently to invest the5 million dollar that's required to do a individualized variable gold level Placebo control double blind study across six months with individuals doing you know weight list individual Shams that's what's needed and that's a $5 million study minimum no one has the has the stake to do that so the nice thing is the nice thing is that the British society's kind of trick trickling down through their official channels are now seeing neuromodulation as a major area uh they were turned on to it primarily by the high-end uh functional MRI feedback World which has a really good literature but it's also you know a very individualized personalized location with the the the uh uh the the treatment is targeted so you can actually Target the anterior singulate for OCD treatment and that that one was one of the first ones to emerge but there uh there's uh there's uh Meg feedback uh that also was very uh uh interesting to them it was uh blinded and Placebo controlled and uh they used Meg to control the insula and the Meg can see very very nicely subcortically it's Meg it's not constrained the same way EG is and uh they they they modulated pain uh with Meg feedback so it's a neuro feedback but is Meg not EG based cool you can you can localize the insula with Loretta and do it with each G as well but uh the the this particular study meeg which is obviously higher end and very much more uh attractive as a yeah but is all this necessary all these drugs and all this High equipment necessary you know the cortical thic dis rhythmia do some SMR got OCD do some focused amplitude training you don't need all these tools I'm I'm here yeah some of the good old basic protocol thing is the the the portal has opened for those very high-end applications the other things need to jump through um the interest is there uh the scientific Community isn't scoffing at neur feedback as just a bunch of hippies as I say I have to apologize for that reputation yeah your fault you know yeah you know I was there you know long haired you know so Dr Hill you let's go back to that five million okay magic Wan five million what does that get you and how can that move the field forward so if I put a business plan together and I came up with the five million and we came up with this study like that's the input what's the output how does that that's that's the problem the output is hard to justify yeah because the five million investment would probably push the field I mean I one one episode of Joe Rogan that I was on probably gave the field a $5 million bump and that was a break even like seriously like everyone called me the day after or the week after the month after oh my gosh thank you so much I got all this business just because I educated for half an hour about ner feedback as part of my rant for you know whatever so the five million would get you a really good solid study we would do you know would that be enough data though everybody says show me more data that that check that box okay totally you show your feedback happening in real time in the brain as a live process you can demonstrate it actually happening you know as a as a as a visible process that's that's almost like an Erp yeah and um you could do individualized work you could do tailored work following a person's change which is one thing that's avoided or emitted because of complexity in classic studies you could do Placebo controlled with eager or some other CL you know way of being more elegant perhaps if or more creative but you can do Placebo controlled work with eager it's really straightforward um and then you could do enough a large enough end to capture the effect size of the thing you were studying a population interest or a behavioral thing in normals or whatever neurotypicals so who knows thank you thank you for catching that um so yeah five million would get us the the research but it wouldn't necessarily suddenly extinguish 50 years of eh research of little small ends and like case studies and people that believe in it talking a little bit beyond their data and lots of like somewhat interesting studies that show results but not perfectly con you know uh so you have to be a research scientist to convince yourself that Nur feedback Works basically you have to read enough of the research to go oh yeah yeah yeah yeah if you just try to yeah you end up reading Russell Barkley's you know dis diet tribe about how it doesn't work and that and you walk away from that and that's it you know so Barkley used to have a very solid Searcher who worked with him initially Sandra louu and Sandra obviously uh is no longer working with him she works out of semal research at UCLA Psychiatry and does a very professional job and uh looks at uh EG signatures that correspond with various medications and also has done work on metaanalysis for neuro feedback as well as medication impacts on ADD ADHD she's just she's an honest researcher and uh showed neuro feedback to be quite positive in The Meta analysis she was was an author of along with Martin orange so you know I uh Barkley is still being paid he's still a shill always has been he's a loud voice and has a lot of you know uh media out there sort of is the place you end up if you if you start asking questions about your feedback you end up essentially reading position papers from the insurance company saying it doesn't work uh also when I was doing my uh PhD you know and I already had been practicing in Neurotherapy probably for Wow uh 10 years at least um we were all presented with Barkley I mean it was you know I just had to keep my mouth shut in order to pass some of my courses I mean it was at that level then so guys we have a question oh I'm sorry Dr Mar but do have a question um as a lay per this is from t- sunlight uh as a lay person beginning the sunlight okay um as a lay person I wasn't sure if that was a name or something as a lay person beginning neuro feedback what questions should I ask my practitioner very general I know what do you see in my EEG there you go and and have you seen it before have you worked with my with my goal my complaint my particular set of things before how much have you worked with it before you know what is my experience going to be um I think a lot of providers do things differently one to the next and there and many many ways of approaching this can be good yeah the the the necessary part is a provider who listens to you and communicates well with you about what's going on doesn't just you know the input part of this question is like who's who's ask asking I mean this this is as a lay person been getting neuro feedback well uh a lay person doesn't just would you bump into the headset somehow you know uh you sat down and it was on the seat next to you on a bus how did this happen by accident uh you know you're coming to neuro feedback for something and that the reason that you're coming to it makes a big difference in in what you ask for a provider and yeah if you're coming to it for a meditative purpose it's a whole different thing than if you're coming to it with a with a particular complaint migraine uh uh intractable epilepsy looking for control I mean there's there's a a wide range from very severe medical to uh cognitive enhancement so uh the the professional that youd be looking for is going to have a wide variety of different kinds of credential along that spectrum and you you need to be looking for an appropriate professional if you're working in epilepsy they've got obviously got to have specialized experience in that area uh but uh you know uh a psychologist or a counselor or a chiropractic office um a neurophysiology uh group that that specializes in feedback I mean there's there's there's a wide variety of of folks and uh there's also General Health and Wellness devices if you're just a a lay person beginning neur feedback you may end up just trying one of the General Health and Wellness things if there's no particular purpose other than curiosity that made you bump into the neuro feedback world so you know the who you are and what brought you to the question ends up making a big difference in who the answer is in in our third show August 7th I believe uh Joy lunch uh put together nine questions to ask your neuro feedback practitioner I put the link in the in the show note so you can reference that as well plus you know love to hear what everybody else uh asks on their on their intake yeah but I think what Jay said is is perfect just you know the one line it all it's going to depend on why you're there right yeah I mean bcia is a Bas level certification that could be for pelvic floor and and not neur feedback so you you can't just say BCI Aid you've got to look at exactly what kind of BCI biof feedback or neuro feedback and uh are they EG experienced do they have qeg certification perhaps um but you're going to need to see that they experience with the EEG yeah yeah does does everybody use movies or or games or what's the just simple simp keep it simple Pete I like to say keep it boring um you know especially when you're working with uh anybody with an attention issue I mean we talked about this before and I think it Bears repeating every single time if you are trying to help somebody with any form of attention deficit okay U and and what you're training them on uh captures their attention your you know your results in the session are going to look great and it doesn't translate into the environments where they actually have attention deficit um I I think that's the big one um and you know having a little bit of fun here many ways to skin a cat I mean Andrew and I will have different answers um you know Jay goes to a level of complexity in terms of you know the the type of cases that he works with that many other people would not uh work with so it's a huge huge huge it depends you know if if you're working on on on sleep you know are you going after SMR or are you lowering beta and the exit or raising Theta I mean also depending on what you're doing how you're accessing all of that it it's going to rain incredibly and maybe looping back into the question yeah what question should you ask your practitioner please don't ask them uh what equipment they use you know ask them how they use their equipment um you know things like that um I I also think if a practitioner is over attached uh to a system or a protocol and i' I'd love the rest of the panel here to Echo back generally speaking that's that's not the best kind of sign um you want them to have a broad scope of knowledge and then pick a tool that helps them to help you would other people agree with that yeah um I I I I hate to suggest that there's a hard rule in picking somebody with experience but I think time is a teacher that's hard to jump yeah and uh there I'd refer to a study that came out of uh North Texas jeie bammer Davis's group Larry Johnson he sent out the same exact EEG epox already edited to a bunch of different Q services and uh got back recommendations for training and uh when he got them back he he was mortified uh it looked like this was just random uh BS you know and he went into Genie and said this is crazy there's no this is all just random stuff and she said well start to examine it split them between five more than five years and less than five years of experience and when he did that there was a more than five years experience clustered around an area in general they weren't all in full agreement but there was at least a general agreement the ones below five years it was more random so uh there there's probably a learning curve with respect to uh the working with this complex system I I would ask how many years have you been doing this and if they're really really new at it I I I would want to know kind of what their outcomes have been and I i' I'd be a little more leery if they just started yeah and do you have a mentor I think that's that's a big one as well how many years have you been doing this and doing uh and had a mentor I mean this is again one of the very valid critiques of our discipline um and and many of other professions you know you go to school you do a practicum you do an internship you have a mentor you like there there are many many not just months sometimes years where you're working in parallel with somebody uh with a lot of knowledge and experience um who will guide you and and and I don't want to say catch your errors but you know really good uh supervisors um don't let you make any errors if that's makes any sense um but that that's something to really really consider as well in terms of you know the system that people graduate through again I do not want to criticize uh bcia um but you know the lowb bar criteria for bcia to become a clinician is a BA in psychology okay that doesn't give you any experience with working with the general public treating the general public or training The General public right I mean it's a good entry Port point that tells you you know that you you you've done some study but I would say I don't know what the timeline is but you should be working in parallel with somebody um under somebody with somebody or have a really really good Mentor that you can just dial up oh there's my age dial up you know just radar radar welcome back to the show radar asks why do some people get a bad reaction from neuro feedback in your opinion the bill I don't know I mean I I'm gonna be really really uh gosh words fail me but if you know what you're doing you don't get bad reactions um you know you might sometimes you might go a little bit too fast uh so you'll get some brain fatigue or Etc but a good practitioner I I would say when when you give your feedback they'll slow things down or they switch things out uh bad reactions um you know sometimes when you're dealing with trauma and Trauma release you'll get an AB reaction but that's part of the process that's different than a bad reaction and and I'm not I don't think I'm full of myself saying that I think that Loops right back into what Jay was saying you know in terms of experience power goes both ways and you want to make sure you're getting everything in the right direction and you want to make sure that you're driving at the right speed and Andrew what are your thoughts there oh yeah it's fit it's fit for the the the goal the approach you know you can have and and and this is this is where this is why our field is hard at least those of us who work um iteratively and with some Choice around protocols not every provider chooses what they do sometimes their software chooses for them a lot of the time sadly but people that do iterative development of protocols um the the place we get side effects that actually persist and build is when there's a really bad fit of a protocol and when we when the provider ignores what happens afterwards and they keep going and they reinforce yeah the problem again and again because the tools aren't sensitive enough or because they don't know enough as a provider to do this or they can't do it with the tool they've chosen and they just plow ahead and the the the bigger issue there is you can get away with that little bit you you can get away with being a little bit of a bad fit you can push somebody a little harder than they need to be pushed or a little faster a little slower and you can kind of get away with it brain's pretty good at kind of figuring out the imperfect ask and sadly if you're not used to watching for that and gently staying in the middle of your lane so to speak with getting the good effects it's mostly okay until it's not until somebody's really overactivated with anxiety or really has disregulated sleep or you've exhaust the the person with seizure so much the seizure breaks through um and these things do happen and I get people all the time who've been pushed into especially anxiety places with certain non-adjusting neuro feedback tools that are sort of black boxes and they get thrown off and it's kind of a sticky effect because they're just told to push through some people don't tolerate that and things go off really poorly really quickly and they stick after 10 sessions 15 sessions of traditional reinforcement or five of a microcurrent simulation or something so I I think there R there that that's the unqualified or the inattentive or I I want to use some stronger words here um you know people that aren't doing the job correctly so it's not that neuro feedback per se doesn't work it's the practitioner the person applying uh the Nur as you said if you have one of those black boxes and you're just pushing a button um you got to be really careful the other thing is I know we don't go over protocols here so I'm not going to say which ones but there are certain very specific protocols that I never do more than three in a row and even if the client is going yay yay yay it's like no we stop at three and we get we can switch off to doing something else but we have to let the brain settle down because that fourth one I'm not going to say it's going to pop you but it could be too much and again those of us in the field or those of us when we were younger had really strong uh mentors and guidance we we we know these type of things so I'm gonna okay maybe I will be a bit arrogant here if you know what you're doing um this doesn't happen or you catch it or you prepare your client like tell me if you start to feel fatigued tell me if you start to get a headache or if you don't want to push somebody into the negative you're just you're waiting to hear that you check your notes you check your data right you you don't let it get that far at the same time we can't really claim 100% success in our field our if you look at the general Publications we get an 80% success generally sort of reported it's sort of a soft criteria the client got something out of the training uh but it's it's also a bit of a coercive question the therapist is ask if you got something out of the training that they just invested a year with you V you know so uh it's a bit of a coci of questionnaire sort of a an answer as to how things went but it's better than not asking and okay uh we have somebody that is a uh a newcomer to neuro feedback and this doesn't sound like a newcomer question my kid has diff few slow brain wav and T5 C3 T6 I'm desperately trying to help my kid yeah sorry the sunlight we we kind of missed uh the question there we didn't not mean to answer it um of course we don't really want to be giving clinical advice on a on a live stream right so it's a little bit like we're we're we're Educators more than than any individuals um I also don't have your data thank you for sending it I always love data and i' be happy to talk to you of course about it and do but there's a difference between diffuse slow activity and specific brain locations that are being named as well well so you know that you're asking for an opinion based on no data so the opinion would be baseless yeah we'll have to I'll have we'll have to dig into your to your EEG I think uh the the sunlight and and look at it more carefully but the fact that you have the one thing I wanted to say the fact that you have your EEG for your son it's a wonderful start it gives you tools to start investigating gives you tools to start developing agency and perspective and to maybe not have to be quite so desperate and start you know taking a breath about the different features and factors that might be operating because it the thing we'll discover in EEG is it's never one thing it's never like here's the diagnosis where is it in the EEG oh well here's this little piece and here's this little thing and here's some of this regulatory feature and some of that that was never described and they're all probably valid so you can you can look for these things and start helping your son guess what it changes it changes and over time it does change yeah over over months or years naturally and over hopefully weeks with with your feedback Jay here's a question that maybe you want to hop into even I can answer some of this there is no college degree available that prepares you for neuro feedback I think Dr Mark Jones at the University of Texas San Antonio would disagree am I right Jay I think he would disagree there's also a college course at sa Brook is a yeah an accredited University that has an applied psychophysiology Orient orentation within their mind body uh program Rex seems to pump out undergrads doing interesting like undergrad level papers with good preparation and their feedback they for like 20 years they have like the little trickle of there must be some faculty who are like really interested in the neuro feedback because we keep getting enthusiastic young people doing really good work out of Drexel so yeah yeah yeah so yeah know up here we even have folks that they're not quite teaching it yet but they have little side gigs so I I think it's it's it's coming it's coming and if you don't mind going International uh Oxford just had a very big meeting uh oriented feedback uh uh quite a few years ago open University had Yuri katov and myself over for a 4-day lecture uh so the you know the universities internationally there's there's a lot of in universities that have uh uh n feedback oriented uh trainings uh uh gra Austria underg Feller uh salsburg Austria under Wolf Gang kemish a lot of these though now you're at the grad level that's the thing I mean the there is no undergrad that really gets you ready to do neuro you gotta do psychology right a bad idea of the back I mean it's like you know modern science these days requires all these different disciplines to do well good neur feedback practitioners and being multi-p specialist scientists so you know you can't do a four or five year you know bachelor's master's program and really get well prepared in the educational aspects because it's not just an education problem you know there's all this like let's stare at signals for five years at least apparently before we get our judgment down about what we're looking at so that piece of it I don't think there is a good training program yes you can do several you know six-month one-year mentorships and training programs but you then have to just do the work and you can actually avoid all the college high level prep some of the best people I know at this don't have the traditional preparation education they've just been doing it for a very long time so you know that might be the number one important thing to check out for for getting confident in somebody's the length of experience I don't want to put it down but could you know you have trade schools out there you have community colleges out there that are not fully populated you know what yeah if we could get it together on what yeah Allied Health this is an Allied Health problem you get somebody in like the LPN or you know other kind of like all become registered as an EG Tech and that's useful because you become very good at EG recordings and understanding waveforms but that doesn't get you neuro feedback that gets you recorded then you go work for a psychologist or psychiatrist and do the neur feedback and become the sort of Hands-On fine-tuning person who knows the brain really well because a lot of psychologists and psychiatrists don't necessarily have the depth of neuron knowledge the physiological knowledge that you need to do your feedback well they have to close that Gap off and Lear fine being a back laab tech right right it's I'm Talent back it served me well being a back leg lab tech looking at 500,000 EGS as they went by so yeah yeah um no we can bring Anthony on this because we talked about this it not the last show the one before as I think we're all in agreement that you know every uh discipline and degree has a scope um and I think you know what this uh commenter said is yeah nobody comes out of a program um you know any type of certified or registered program with the knowledge that you need to to practice I I think that's just a fact um if you have uh MD psychiatry um psychology those tend to be you know the the biggies and have no training in in neuro or EEG I mean I'm not saying you might as well uh have a a ba in in in Fine Arts or something but but you need the compliment the two go together and I would say there are certain Fields where if you have both compliments wow you know and other ones as everybody was saying if you've been training for years and years and years and have a good Mentor that's how a lot of I would say Jay in your days you know how a lot of people got got into this um but I think we also have to put on the be before we go to the question I think uh we also have to be really really careful about people who almost literally just plop down some money take a weekend Workshop uh and then start putting electrodes or something on somebody's head that is dangerous that's the one combo you don't want and there's there's a not insignificant amount of that happening over the past 20 30 years like that that happened the three-day Workshop the two-day workshop I know how to do ner feedback now there's a lot of that yeah yeah that's the danger that that that's the classification you want to be careful of yeah uh biggest problem I see with nor feedback is it seems impossible to make money therefore nearly impossible to scale up you're a Debbie Downer radar well but what is it I think U Linda Johson made this joke Jay it's your joke as well right how how do you make a million dollars in Neurotherapy start with five no the start with two but yeah start with five the the old joke may have been even started by me how do you make a small fortune in neuro in neuro feedback or biof feedback you start with a large one uh the investment in startup of early stuff yeah well I mean I don't mind sharing here we're we're hiring now by the way if anybody's interested in coming up and joining the swingle clinic but um you know i' I've been interviewing folks um you know out of school with their phds you know very willing to train them up um but they can go and make astronomical money right out of school uh in assessment you know in good old DSM guided assessment um this is I mean this is a discipline for the heart uh you can make a living out of it but I mean if if your goal is to you know make a gazillion dollars it's it's pharmacology it's assessment it's all the stuff that we kind of rant against all my competitors in New York City are psychiatrist and psychotherapists charging $300 a session for neuro feedback and they're not doing neuro feedback for 300 bucks a session they're psychiatrists who charge $300 an hour and they use neuro feedback as their primary tool and so that's how you make money is you do something that makes money itself and then you use nerfy back as your tool set that's really many of us just can't charge that I I don't know I just no no I know but that's that's the answer to Radar's question at the individual level now the scalability question um talk to me in three or four months I have an answer for that but I don't want to share it with you now well you gotta train up well 80 80% of your business why worry why worry about scaling it up are you thinking about a damn franchise you know this an access Play you know what we do is access it's giving people tools and agency by teaching them how their brain works so like of course we want more of that if everyone did a attention test in a brain map and understood their own brains we'd have way less suffering in the world yeah would all understand you know how these how we work with our stress and fatigue and attention and would would modify or adjust or build accommodation in so increasing the quality of practice this across the field is a good thing but uh if if you're worried about ramping something up uh uh again access feed people that have done franchise franchise work out there have run into difficulties but that's you know if you do a franchise you have to have a every state has their own franchise laws yeah and there's a couple's a law 50 something states to to keep all the franchise stuff straight there's a group with almost 400 brand licenses it's not a franchise a brand licensing model in our field now throughout the world there's there's a couple really broad players but what that ends up being is a bunch of people who didn't used to be Affiliated just being random doctors with their name under a brand somewhere so when you call them and say yeah hey I want an appointment they don't answer the phone with that you know brand name necessarily it's just like a marketing umbrella for them yeah but you have to be careful the brain Mills you know we have the brain spas uh which I think all of us can comment on um in a negative way and we also have the brain Mills you know where people really aren't they aren't paying attention to the individual's EEG and I mean I don't think it's happened yet in a in on a big scale but I think you know people are going to hit the wall you know we're gonna have some damage in order to have scale you have to have standardization so so you can ensure the service can go beyond and I think the best thing I'm by standard yeah standardization I think is where we get into trouble because I think everybody here again will really agree there's no standardization of the individual brain yeah but I think saying is that the technolog is not robust enough yet like you can't you can't just put a a hat on and know that signal quality is good still and I don't want to hear about our AI headsets and things they don't they don't solve the problem yet yeah the technology has yet Advanced enough that we can like do it without knowing the technology I guess where I'm going with it Dr Hill is neurologists won't listen to us because they don't believe that the training is the same so they they they discredit whoever read it because there's a gazillion ways that you can look at it it's too subjective versus if there was you create converts one by one I have tons of psychiatrist that refer to me that did not believe in Nur feedback but got desperate with some random hard case and decided oh that guy does uh let me see if he has any ideas and they called me let's get a brain map and I look at a brain map and cold tell them three things that they didn't tell me oh okay maybe there something here do some Nur feedback and drop the seizures the auditory hallucinations or the oh wait a minute and now we start getting referrals so you just create you know there's nobody quite so uh anti-cigarette as an ex smoker you know the same there no one quite so vitrio like like supportive of neuro feedback as a former skeptic if only like Lifetime Fitness or a brand like that would get involved to put some of their Equity behind it and uh I've I've never found neurologists to be a problem with my work but but then I work directly uh in neurology epilepsy and um and EG qeg uh clinical work so um I've never had trouble with that uh I was recommended as a speaker on qeg to the uh the registry society's annual meeting their 50th annual meeting uh Mark newer recommended that I do the talk on qeg to them so you know it's the world out there isn't as hostile as everybody thinks it is necessarily not anymore it you know one neurologist at a time um and just like if I don't know something teach me same thing with the neurologists they don't know something teach them and speak speak with them as a colleague I find the psychiatrist psychologist is hard hard group sorry I the psychiatrist and psychologist specifically is the harder group like the the regular General MDS or neurologists specifically in the brain are not that hard because they start talking to you and they instantly know you know what the brain is doing oh okay and so they're they're right there with you and they feel like you know if you can talk intelligently in their space then you get respect but neurologist yeah but General psychiatrists and general talk therapist psychologists at the PHD level is among the most resistant group to then referring I find to their feedback but the Master's level the terminal sort of in the trenches licensed social worker clinical mental health counselor etc those people are really Pro referrals I get a lot of my robust referral networks from Master's level very deeply caring very skilled very broad very exp very experienced a therapist who are just too busy to take everyone they see and have a lot of ADHD and Trauma walking in and want that dealt with you know differently but psychologists who are like well I'm Youngy and I want to sit with you twice a week for six years before we talk about what's going on next you know they're not really about getting to the the physiological intervention the same way I find so well I mean it's you know do you see people as a a compliment or a competition I think that's the big one and you know I my my you know degree or the little letters I have is it's PhD in um psychology right um and I find for many folks a little bit of counseling uh can really help along it's a beautiful compliment um and then there are others wherein yeah you can you can talk and talk and talk until the cows don't come home um uh and uh you you go nowhere you need to get in there on the brain but again I think it's the way you you you talk with folks right um and every discipline you know go to a surgeon they're going to recommend surgery go to massage therapist you're going to recommend massage right but how do you differentiate you know when surgery really is necessary um and when massage is and surgery will will hurt right you know yeah all right everybody we're we're at time unless anybody got any I'm tired I was up late last night I don't know why hardest one is Dr Hill Anthony Ramos Jay gunkelman Dr Marie swingle and radar and the sunlight thanks for uh showing up adding some content hope hopefully we help remember check with your primary care physic first because this is for entertainment informational purposes only have a great night all before you though curious what who were what were you talking about before with the stroke uh when I fman fetman sen or senator from Pennsylvania because he was doing this combination thing where he was uh relying on an audio prompter sorry a visual prompter to do translation before he could respond so he's working around auditory input of fasia was our Theory I think we're gonna talk about that on tomorrow show if anybody's round Jaye Dr Marie all right guys's over bye okay