 The key things that I want to accomplish here is to show you a little bit about the program, but I also want to introduce the importance of interacting with the clients. So we're working with computers and equipment. This afternoon we'll talk a bunch about how to enhance your practice, and a big part of it is being genuine with your clients and explaining the things and educating your clients. So let's go ahead and do that. I recruited a volunteer. Can you come join us, please? Oh, we switched up on me. Okay. Good. Okay. Good. And that actually will tie you nicely to have the same person do with the neurofeedback. So things always work out. I'm going to need to just get you to slide over enough here, so this computer monitor is not going to be for your watching. Julianne. Julianne, hi. I'm going to put this on your ear. So let's get a little bit of background. Ostensibly you're here for something, and you can make it up if you like. Okay. But what we're going to do is measure your sympathetic nervous system, and I want to begin to teach you how to keep that in a nice balance, because most of us are overalls, and there's two parts to our system. There's our sympathetic nervous system, and our parasympathetic nervous system, if you think of a car. A car has a gas and a brake, and nobody wants to drive a car with gas only. So in life, we don't want to be driving without our parasympathetic nervous system, helping us out along the way. So what would be something that we could talk about that... Yeah, my quick elevator story would be a former All-American athlete. And eight years ago, I did a brain injury in a car accident, and I've been in therapy ever since. Okay. So I have autonomic nervous dysfunction, especially in the visual motor area. Okay. So there's a true physiological component here. I need to be respectful of that. So this is like Diana was saying, don't just charge in. Okay. So what I want to do is say that anything uncomfortable that you feel, we're going to stop right away. This is not a no pain, no gain scenario. Okay. The idea is to help you be more relaxed and to feel calm. Oh. Sorry. Good, good. All right. So to help you feel more relaxed and calm, not uncomfortable in any manner. As a side note, if somebody has trauma and may feel too relaxed, that could be a very uncomfortable condition for them. So that can actually lead to anxiety and sympathetic arousal. So without knowing enough about you, I want to be very careful about that. So I'm going to take a few more stops and pauses in this and I normally might. Okay. I actually did this once in a presentation and the woman almost passed out on me. And she was like, oh yeah, I have had a lot of trauma and so I've learned to ask a little bit, not just think everybody in the room is perfectly normally adjusted except me. So what we're going to do, I just want to see your best relaxation for a few minutes. So I'm just going to take what's called a baseline and I'm going to take some measurements. This shouldn't hurt you. I just want you to do anything you would normally do. Don't try to do anything different. We just want to see how you relax. And so what I've done is I've... Oh, can't find the center. Easy fix. You never want to get panicked when something like that happens in front of 40 people. Stay calm. Do your own heart rate variability. And so I'm starting to look at things already and this is a measurement of her pulse using the HeartMath program here, taking a baseline that's disturbing to get back. So HeartMath uses what they call a coherence ratio. That's over here. And it measures in low, medium, and high is their terminology. And you want to be in high coherence. You want to have a nice high amount of synchronization between your physiological system and, of course, it can drop to medium. And then also go to low. So right now, doesn't this look... Oh, but you see what happened? Changes are happening. So you start out and she's 100% in the green. Now, she's also got me in the background talking and I'm talking about her, so there's distractions and that's going to change things, but isn't that perfect for our demonstration? So we see changes that are happening. These red lines are a break in the recording, meaning something physiologically happens that interferes with getting a true recording. Now that could be anything from a smile to it could be hyperarousal, it could be tension, but it lets you know something's going on. When you have your equipment set up, ideally I can't do that here, but I want to have it set up so that I can be like this, so that I'm a coach, not that I'm just taking measurements here and looking and I don't care about what's going on over there. So... Am I supposed to stay still and not talk and not smile and all of those things? Well, you're doing your best relaxation. So whatever's relaxing for you, okay? So if you would be in a stressful situation, if you're upset, what would you do in order to quiet yourself down? And I'll just give her another minute. I usually run this for three minutes because you see a lot of changes happen. We saw she started at 100% in the green, but then that changed again. We can take into consideration why that changed, but let's pretend this is a clinical situation because these changes happen anyway. Okay, Hartman has what they call a power spectrum. Essentially, what you want to do is measure there without getting into a lot of terminology. We're just going to stick with the Hartman terminology for here so that I'm not switching back and forth. But we want to measure somewhere in this light blue and you can see this jumps around and this is looking at the ratios that we talked about earlier where if you have a very low ratio, that is usually an indicator of stress. Likewise, a high ratio and now things are settling down here and moving into a more stable realm, the realm that we would like. And look what's happened with her breathing. So their measurement shows a very nice rhythm of heart rate variability happening. Remember, the Barriflex records first, so there are going to be changes in what she's doing that there's going to be a delay from when the Barriflex records that and sends that information to the brain and we see a change ultimately in blood pressure and heart rate. So this can look good before we actually see a change in the coherence ratio. Alright, so we're looking at very nice, she's stayed nice and stable so we're going to stop that and you can take a break and that actually ran a little bit long for somebody that I'm taking a measurement of I would have wanted to check in with her how are you doing, everything okay, it would be good to continue, I would have been watching you a little bit more closely making sure. And what I would have been doing is watching the rhythm of her breathing at the same time. So I'm watching is her breathing happening up here, is it happening down here in her belly? How quick is it happening? The last person I measured did three seconds of breathing in and eight seconds of breathing out. So we knew right away that we wanted to make a change on that. A lot of people will say, oh yeah I read about this and I do this in yoga and it's supposed to be six seconds in and six seconds out. True, that's the average but what we're looking for is your ideal. So that's the beauty of the biofeedback here. I've had plenty of yoga teachers come in and I'm like we could really improve that and I think you'd feel a little bit better. So can you see over to there? Yeah. Alright, so now I'm going to do a little bit of lecture about heart rate variability. Good, alright. So what we want to do today is work on something that's been going on for ages and ages back to when we first started to understand human physiology and think about it even if we didn't have the terminology that we have today we were aware of the fight or flight reflex that we have and back in the time of the caveman this was a very important reflex to have. It meant survival or not. Caveman's walking along looking for food and a bear jumps out they have to decide am I going to try to get dinner or am I going to try to save my life? We still have that same physiology. We have not evolved very much in our brains in that regard but we do not any longer have bears jumping out at us so not responding to an email might look to our brain like a bear. It needs to respond. So let's just understand a little bit about how the heart and the brain are connected. I'll talk to you in a moment about the vagus nerve but first let's understand whose job is what. So who is responsible in our bodies for our nervous system? Do you think it's our minds in our brain or our body and heart? Yes absolutely. And what about what controls our neurotransmitters? Where do you think they are controlled? So we've got a smarty pants here. A lot of people will start out with saying neurotransmitters brain and then organizing incoming information they'll think the brain but yes your heart helps with that too and you can start to see everything. We're educating a patient you're better than the average patient so we want to be clear that the heart is not a metronome it doesn't be there are chambers and there's a rhythmic process to it and that's what we want to do is we want to find your ideal rhythmic process and then see if we can interpace that with the rhythm of your breathing. Those variations are important to us that's what allows us to be as adaptable as we are and so we're going to be taking some measurements and ultimately what we want to do is see measurements that look nice and smooth most people can look at that and see that that just seems like a better thing than that and when we get frustrated when we get upset when we get worried when anything happens that we're activating our physiological arousal we are at risk for losing that interface in our system so our goals today are to understand how it affects your body hopefully, again you would have come in with maybe less understanding than you have so hopefully you already have some improved understanding of that we're going to learn how to control your personal heart rate variability my goal is to get you to learn something today so that when you go home you feel like you can practice it and practice becomes a very important component of this like with anything else we can do it once or twice but if you don't practice it's not going to have the magical effects that it can have there we go we're going to have to practice let's talk a little bit about how heart rate variability affects the body the vagus nerve connects the brain stem it swoops all the way through your body and connects to your gut your whole body is connected via this largest nerve in your body so if we look here it connects all of our organs and we're going to look to help teach the brain the vagus nerve how to be more resilient and how to keep itself more quieted so we've got the whole overview of our nervous system and when we are activated when the nervous system when the brain detects that there's something that puts us at risk our body becomes sympathetic and start to activate our organs into our fight or flight reflex so things will happen our pupils will dilate things if you look at these do any of these things happen to you as a result of what you've been through? we've got accelerated heart rate some people feel that I'll get an accelerated heart rate I'll have sometimes a slight urinary incontinence that just makes no sense because I'm not sneezing or coughing or anything yeah the gut stuff a lot of people will feel their anxiety and how do you know you feel anxiety I feel it in my stomach so here what you want to do is help people identify how do you know you're anxious if I came from Mars and I never heard of anxiety but you're telling me you have some anxiety or you have some loss of control help me understand where that is in your body yeah and mainly if I'm really anxious my voice, my throat constricts and then I can't speak anymore so I usually carry it more up here in my chest and I'm actually a lifelong asthmatic so I don't know if that's been a factor of my whole life in my asthma I actually really do have asthma it's kind of a question I ask now so you have a lot of nice awareness about your physiology and that's going to be really helpful and that'll help us to be able to measure how this is helping you a lot of people don't have a way of knowing if they feel better but you're so in touch with yourself that we'll be able to tell what kind of changes you experience you might even feel that today you want to give a little bit of a suggestion I expect that this is going to happen look at how good you are at knowing yourself somebody as good as you is going to feel a nice effect sometimes depending upon the level of the person sophistication with you I would talk about the amygdala and how the brain stores information and how it likes to access that file people with chronic pain that's an important concept for them to understand that with chronic pain the fight or flight system the amygdala is super activated it wants to protect them alright so now I don't want her to see that so we took the baseline you're good you're good so I wanted to tell you a few things that I'd like to work on now she actually did very well so I want to ask her rather than tell her how did you do so well what did you do to relax yourself well initially I didn't I thought I was going to see something on the screen so I kept waiting and waiting and so I was just but then when you started talking I was like oh I guess I'm not going to see something on the screen so that must have been when I changed that I was like I'm just assuming I changed because you said so and so then I that made me anxious like I'm not going to get to see what's going on and then when I asked well what am I actually supposed to be doing here again then I just closed my eyes so that I could just shut out everything else and I didn't try to intentionally breathe for some reason I have I have trouble with that oh you did very nicely with it so close your eyes that's an important piece of information when you close your eyes if your brain is well adjusted your alpha should increase okay so people whose alpha is not regulating don't close their eyes they don't like it so that already gave me a little bit of insight so we'll see if we see that when we get to the neurofeedback as well okay but I like hearing that I like it when somebody likes to close their eyes and so you did a very nice job of relaxing yourself here what we're looking at is the rhythm as measured by the sensor that we have on your ear developed a very nice pattern there's a little tiny hiccup in there but that's okay nobody's perfect where you know what we want to do is get this to be if we could get this for all the time that would be super good so what we want to do is get a nice measurement of understanding how long do you like breathing in how long do you like breathing out in order to achieve this so I'm going to have her teach me first before I start teaching her and ultimately what we want to do in addition to those beautiful waves that you made is we'd like to get this peak to shift over to here a little bit okay this peak if it's quiet or if it's low it's telling me that your mind is a little bit talking and that fits with what you were telling me you were thinking about a lot of things while you were relaxing and again it's a demonstration but this is something clients will have too I was thinking about if I was doing it right or I was thinking about why I can't do it they think about a million things so we want to get this just this peak shifted a little bit so let's do it again and I'm going to watch your breathing a little bit better this time and I'm going to let you see the screen and all we're looking for is to make nice peaks and valleys like that and after we collect a little bit of data we'll watch where the peak is there it will move unlike what now we're just an average so we're collecting, we're just getting a reading and if you look at this over here I usually count to myself so one, two, three one, two, three two, three one, two, three so the out is a little bit longer but that's okay just without there you go nice and I think that's happening because you're making that breath just a little bit longer a little time a bit longer let's keep watching I can see she's got nice belly breath going on so that's good as you're breathing in the air is going all the way to your belly which I like and could you put your hand on your belly so that you can feel that because when you're at home practicing that will become a form of biofeedback for you oh isn't that lovely let me see the red because I had her move so that's not a problem we don't care about that I made that happen and let's have you put another hand up on your chest and see if we can create a little bit less movement on the chest and bring the air all the way to your belly so if you could imagine for instance that there's a balloon in your belly and as you're breathing in you're filling up the balloon and as you're breathing out you're emptying the balloon so the air goes all the way to the belly and then breath out I'm actually making it harder for you I know if I can not put my hand there okay if I touch your bottom hand let's take a break and how does that feel it's going to feel a little different you usually don't breathe with me holding on to you therapy where they try to retrain my breathing and breathing was one of the one of the first things that they do is that I had a brain injury so I wasn't breathing correctly or whatever correctly okay if you light-headed so it's just hard but you the coordination of it if you actually feel it's actually got to be that I could feel I could feel that I could feel that that was actually okay and do you know it's hard to do and especially if you have other intervening variables that are definitely making it harder for you if you can do this laying down so if I were in the office I would have her lay down and I might put if it's a kid I usually put like a stuffed animal on their stomach or something adult maybe a box of tissues but when you lay down it's easier to get that air into your belly so when we tell people to practice at home practice laying on your bed practice doing this before sleep I think what I'm doing is I'm feeling is instead of coming out I'm feeling to go out to the side I think what I'm feeling is that the belly breathing is not so much coming out this way it's coming out to my sides versus here it may be because I'm sitting up like it's not a familiar feeling to you so it's a change and that's how we're going to get really good at this is to see changes happening so I don't want you to feel unhappy that you're feeling it at your side that's much better than feeling it up here yes so if we can get it to the side there's no reason we can't get it to the front in the future it takes a little bit of practice and one of the things that happens is once we have established a way of our patterns of physiology they're going to take a little bit of nudging to break so that you already made a change that's terrific and I think the sitting up for me is wanting to engage and it's probably a protective thing it's like okay there's a whole bunch of people out there I've just sort of armored up a little bit here so to get it to go out towards the audience it's like it doesn't want to do that at all let me ask you this do you have a busy mind or a quiet mind? very busy she knew that right away okay not everybody knows it who doesn't know it are the people that have quiet mind so raise your hands raise your hand if you have a busy mind see how fast that goes raise your hand if you have a quiet mind okay and raise your hand if you don't know you have a quiet mind okay people don't know how anxious they are till they feel less anxious and people don't know what a blessing it is to have a quiet mind until they don't have it so with a quiet mind person you can do things like start to engage emotional experiences that are pleasant so HeartMath actually wants to teach you to teach your clients imagine times where you felt appreciated imagine times where you felt really good and calm and connected busy mind people turn that into a nightmare they'll be like okay yeah I can remember the time I went on vacation and I felt very calm and I haven't been on vacation in a long time and I got to start looking at my checking account because I haven't balanced that in a long time and they just go up and run away with it don't do that with busy mind people don't give them that task give them a task like imagine your organs being connected and as you're breathing I taught you about the vagus nerve I just want you to think about your organs only your organs and then ask is that something you feel like you can stay with if not imagine a whiteboard you've walked into a classroom and the board is totally clear you're sitting down you're going to work on relaxation but anything that comes in your mind is going to get written on the whiteboard and erased your job is to keep that whiteboard clean that's your only job and that keeps them busy okay because their thoughts come in they write them on they wipe them off if two come in at a time they have to wait their turn one at a time wipe it off I will do the counting for you so let's do this one final time and here we go again I'll do the whiteboard yes now you're going to do your best relaxation I'm going to take the microphone from you again I'll hold it for you we light the hand on your chest and your belly so go ahead and let's do that and we've got that nice count that was working well I'll count it with you in two three out two three and if it works for you breathe in through your nose as you're doing and knife out through your mouth imagine there's a straw in your mouth you don't have to blow hard just let the breath come out through the straw I'm going to rest my hand on you again two three two three keeping the whiteboard empty and fill the balloon you have two jobs and only two jobs the air is going past your heart past your stomach all the way down to your belly there you go all the way down passing the lungs in the heart the belly when you're ready you can take a break tell me how that was for you the whiteboard was impossible oh too many thoughts we didn't like that I just couldn't even I couldn't even see in my mind's eye I saw this board I couldn't really see myself am I supposed to be sitting in a chair in front of this whiteboard do I go up there do I get up every time when you started queuing me into my organs that was much easier okay so good so we're going to work on the organs you could see if we want to look at her history she actually did worse than she did on her own let's pull up a quick history right because the more I try to think about some task yeah so there's her first one all by herself we see some nice coherence in there and then the second one pretty good but that was there's some physiological disturbances in there the sensors just not even reading third one not so good there's her whiteboard and there's what she figured out on her own okay and we need to let our patients be our teachers there is not the way to do things our job is to be coaches we have a student we have someone we're coaching and we're helping them find the best way for them to be successful so hopefully that now this is an amazing lesson because many of my providers have tried to get me to just empty my mind and be in touch with my body but my habit is to be a thinking you know I like that's where I'm comfortable that's where I think I'm comfortable but evidently I'm not like I can see here I am not my best state for relaxation so it's a you've just demonstrated to me how I must change this pattern break out of what my perceived comfort zone that how false it is so what do we do with this I'll take this off thank you we practice this is not going to help you if you don't practice we we have hundreds and hundreds and hundreds and hundreds of hours of practicing being over aroused so we have to put many hours into stabilizing our arousal not hundreds and hundreds and hundreds that's the beauty of things we can learn them the body likes to work efficiently when it learns to work efficiently it's going to hold on to that so I the research on this is 20 minutes twice a day that's what improves heart rate variability I have had about five clients in 15 years that would practice 20 minutes twice a day don't do it they just don't do it but if you can get somebody to practice three times a day for three minutes a day now you're starting to have an impact and people will come back and say oh I was having a fight with my husband and I tried to do that heart rate variability and it didn't help of course not you've got to get good at it first you don't like go to the pool and jump off a high dive before anybody even taught you how to dive off the side of the pool so we've got to practice and then we'll go to the high dive and take this into a real life situation that was a great demonstration it was you're going to feel disturbed for a little bit do you have this program or do you have a the program itself is not expensive at all a couple hundred dollars like I said the app on the phone is very robust so I wouldn't shy away from that the sensor cost about 150 dollars so what can you add to that I would like to add that thank you very much it was a great example and I think it really fit perfect what we want to teach it today because when we talk about breathing and respiration to our clients the other day I was telling my client okay we're going to learn how to breathe I said oh yes I forgot to do that all day right I was like yes it sounds so simple it sounds so ridiculous it's something that we do all the time but learning to breathe properly to self-regulate is a whole other another page that we have of the background that Angelica explained us so you need to educate the patient to understand the importance of doing it and you saw that even a simple physiological function can be very hard and for people that have some trauma experience it's very difficult it's extremely difficult to focus about the breathing to connect with their body and as Angelica said we need to be the coaches there is not a way there is no one way that we will work with everybody this is why you need to have very good supervision and mentors that can help you to go through case by case and of course you will adopt your experience but yeah there are some people that if this is not working even that you start building up it's baby steps one another this is why we have other physiological training that we can add find that could be easier to begin probably somebody will be easier to start just with temperature skin conductance or the opposite we usually try to integrate first some techniques of biofeedback and then neurofeedback but I have lately some patients that there are studies connected to their body that it's so hard for them to identify their physiology that I needed to start with neurofeedback so then we could go down to train biofeedback so it's really very individual and you need to you will learn a lot with each of your patients and your clients so it's not as easy as it looks and you need to get the proper training and support to help to help people but that was a great demonstration so now we want to demo an neurofeedback session who here hasn't seen a neurofeedback session who hasn't who has not one person the rest of you haven't seen a neurofeedback session and I know they are streaming live so probably some people outside here they would like to see how it's a session so we will do a very fast demo and I know you have a lot of experience some of you but we just want you to demonstrate how it's a session, how it's a different equipment unfortunately I don't have my equipment with me so I will need some help here using this equipment that I'm not familiar but the bases are the same this is a good moment to talk about different equipment and how you can decide what equipment to use many people just call to ask what type of equipment you are using if you have a successful as a successful cases a successful practice thank you that means you have the right equipment right and we are like no the equipment doesn't make you better clinician the equipment is the least important it needs to be a successful clinician all the equipment everything will do more or less the same everything you find in the market will do more or less the same so have different graphs different games different things but the bases are exactly the same so the equipment won't make you better clinician your training and education will make you a better clinician what side okay so Juliana we don't know what is going on in Juliana's brain right so I need to be very careful what I try to do even for a demo practice so I'm not going to do a real training right now because we don't know how she can respond but we'll do we'll run like two minutes a couple of minutes session so we can understand a little bit so we I will that's my my orientation I will prefer to have a brain map I have the brain map with me I have my full clinical intake including medical records when we're talking with somebody outside in the break it's like how important is to know the medical background of the patient to understand is something going vascular something that we don't know and we have risk to use this instrument so you need to have a full medical records to understand what is the medical history risk medications very important what type of medications they are using so we have everything integrated and we decide the protocol okay for this demo we decided to train set over the somatosensory cortex in right in the center of the of the scalp and we need we always use if this is one channel training is the most simple protocol and we always need to have at least three sensors connected to the patient so we have the active electrode the active electrode is the one that is connected to the training site okay the location where we're going to do run the training then we have the reference and the ground okay the reference is the other channel the other electrode where we're going to read the brain activity okay this is electrical activity it has to run from one side to another right so we need two spots where it's running and we are reading the electrical activity and you need the ground so Arthur is helping me to prep the skin this is very important to have good connection we need to make sure the electrode is well connected to the scalp we're trying to measure very tiny activity right so all these conductive paste and sensor are helping us to amplify and to see a big signal so we are able to train it so we really need to make sure that the skin is very clean we use a proper conductive paste and the proper supplies to have good connection it's very important to do this properly we need to explain the patient that there is a procedure sometimes hopefully not could be uncomfortable rubbing the skin until it's very clean and we try to connect are you okay? okay so right now she's all set up she has her active electrode her two reference this is a device that the reference go in the mastoid on the back of the ears okay there are some equipment that use reference on the ears or could be somewhere else in the body but this is a more typical the ear electrodes or the mastoid electrodes so she's all ready and we are going to try to read her brain activity can we just see the raw signal without training just to talk about it yes? okay so we're not training right now okay so I can talk about what we're looking to the screen okay so this is what you will see most of the equipment they will show you what you are going to train right so this is the raw EG signal and then they have the different bands here so they divided the different bands so you can clearly so when you have the raw signal the first thing you want to see is that there is a real and clean brain activity and real means that we don't have electrical activity in the environment that can contaminate the signal or of course the natural artifact or contamination that is movement, eye movement, muscle tension and some physiological functions that can interfere with the brain activity so we need to understand what to read that, how we are looking at so this is a whole six months course to learn how to read an EG and how to identify artifact and how to identify if it's real activity or not but if I ask Julian that she needs to be relaxed and calm and try to do this with your eyes open or eyes closed probably closed so you don't see anybody this is a whole other subject about training with eyes closed, training with eyes open there are some people for personal reasons that prefer to do it with eyes closed eyes open this is why when we record that QEG we do it with eyes open and eyes closed this is one of the reasons why we need the data eyes closed as open but also it helps us to identify what would be more efficient to do the training with eyes closed just for the demo and we'll ask her to close her eyes when she closed her eyes when the patient closed her eyes it's much easier for us because then we won't have artifact of the eye or at least a little bit less there are some people that when they close their eyes they have eye fluttering but it looks like she doesn't have much fluttering and she has a little bit of eye movement not much really so now the next thing is ask her to relax and I know just saying this can be very difficult so people just try to relax and then the opposite so you just make them feel comfortable try to talk them softly try to help them to find the comfort zone and try to guide them in the best way so they can actually relax so you have to prepare them you need to know very well your patient to help them to find a comfortable state where they are as relaxed and when I'm talking about relaxed I'm talking about muscle relaxed I will talk about later mental relaxation but right now it's important about muscle relaxing you need to have the proper sitting for the patient there are some people that feel more comfortable sitting straight, there are more people that recline a little bit can be comfortable I definitely prefer to have some support to the shoulders so there are many people that carry a lot of tension so just being a little bit supported help them to better relax so help them in that to find the best position the best sit and then probably the hardest is helping to relax their face their jaw it's very easy that they get tense here and being tense from the jaw it's very easy to contaminate in the temporal lobes they get that evident because we are up here so we won't see that evident but if you are training in the temporal lobes and they are tense here it's very hard to have a clean session so actually many times when you are training on the temporal lobes the first sessions are just helping or teaching them to do to learn how to relax their jaw or probably you will start with the MG value feedback and teach them how to relax their jaw or how to jump into P3D4 training so actually she is doing pretty good in being relaxed now you give them instructions about helping them to find the mental strategy to have a successful neurofeedback session and this can be a whole lecture about mental strategies what they have to think about it what they have to focus about it what they need to try or not try about it and you can explain in different ways depending of the patient but really this is not a cognitive task they don't have to try cognitively anything or voluntarily anything they just need to get the brain get the conditioning and go through the session for many people this is very hard to get they need to try something they need to have the control of the session they need to understand what they can perform better so sometimes just the first 3-5 sessions is helping them to find the mental strategies so they can leave the brain do their job give them a specific instructions sometimes it's not very helpful ok so giving them a specific instructions about imagine you are in a very relaxing space you are in the beach you are with your pet you are in a warm space it could help them to in the ideal world is try to give us less instructions so they can figure it out their own mental strategy Eddie Dulliver he is in University of London doing some research about phenomenology of neurofeedback and he has a very nice study where he put 3 groups one group he gave instructions please pay attention the screen second group try not to pay attention to the screen just try to think about your ongoing day what you are going to do after here tomorrow the third group didn't give them any instructions whatsoever just sit them there leave them alone who do you think perform better which group perform better or learn better the third one they figure it out by themselves so this will be in the ideal world but of course we cannot just hook them up we need to give them some information so I I give them this information actually the same that I just told you this study and I tell them I need to give you as less instructions as possible and you need to figure out your mental state okay you will have the visual cue you will have the visual and auditory feedback this is something very important that you need to consider when you are running a neurofeedback session you want to make sure you have an accurate visual and auditory feedback this is operant condition and training and your brain needs to understand when he is in condition or not okay so this is why we are getting some with super entertainment neurofeedback games right of very busy with visual cues and auditory cues or just leave them the video without very clear feedback so you need to find what is the most appropriate screen for your clinical objectives and for your clients as well right because there are many preferences there are people that really get engaged in some type of screen if it's a children of course we need something a little bit more entertainment so they can actually sit and perform something but really having just a green light with a beep this is as efficient as having these very fancy video games and graphs we are just sitting with an ADHD kid with a green light and a beep they will come back after one session right so just try to address the screen that really fulfills the operant conditioning the learning procedure and that your client feels comfortable and you can give them the options and you never know we have these puzzles with pictures right and let's say landscape pictures in a forest and then my client is so anxious in a forest environment so they are getting worse if I shove the forest no forest so we need to ask depending on your options I have this, this and this what do you think you will like and you will feel more comfortable and you like it better so these are all the things that you need to consider but I am talking not much but well you have here your raw signal you have your different bands and then you have to choose your protocol right based on all the information that you are gathering the most conventional protocols you try to inhibit some frequencies and you want to reward some frequencies the brain learns better and faster if you tell them what not to do right the only inhibition protocol is not that the brain won't get it but it will take it longer to understand so you always want to tell them you cannot do this but you need to do that and if it is a reinforcement protocol it is okay for you to do that but try not to do this you always need to have the inhibition and the reward for the learning purpose so the learning procedure happens faster and better so you choose here your inhibition bands and your reward bands that I don't have idea how you choose it here but here, here okay okay okay right now she is training there is no feedback there is no feedback hopefully so did you see how we have the three bands inhibition and the reward and every time here, okay so Juliana is seeing nothing because she has her eyes closed do we have audio if the patient is going to do it with eyes closed then she needs a very clear auditory feedback so the brain gets one sensory pathway to learn so yeah probably if we don't get the audio okay but let me explain here you have your band this is also visual cues for your patient you need to explain that these two bars we need to have it underneath the threshold this bar is a reward band so you want it to make it larger and bigger so this is a visual cue before you start running the training of course you need to explain here what is in the screen so they need to choose what they can pay attention or not so they have the three bars and then what happened in the picture nothing Christian are you more familiar with Nexus you use it more often could you come up here please just to get the right screen to come up in terms of that's audio audio that screen what volume I think it's actually for eyes closed okay so the audio is having like a relaxing music the volume is switching it's alternating so the volume of these it's conditioning to if it's in targeting and getting the thresholds in the three bands simultaneously for a certain amount of time then she will get increase of the volume right if she's out of condition she won't have the high volume so you explain this ahead of time okay so the audio it's a little bit low but basically with eyes closed this is the feedback the audio it will be louder or lower depending on the condition and you just let them find their mental strategy if they can actually achieve the feedback and just to give gentle reminders about being relaxed and about being alert right when they are with eyes closed it's very easy to get in a drowsy state and go to sleep but of course we want to make sure they are alert and you can read that in the raw signal if they are getting drowsy you will see more higher data activity slower so you can bring them back to be in alert state and be focusing the music and the sound okay I want to stop now here I'm going to stop because I just don't want to do like a real training we don't know what response she can have but well yes no okay but she's no and I mean I'm glad everybody most of you have done a session but I think just to have a little bit more of details or ideas and I know every clinic has their own tricks to help the clients and the patients to perform better it's very good because this is learning we need to give them feedback about the session right somehow or another and and you can show them the raw signal and show them what was the amplitude through the training if the session was not as successful try to give them yeah you show them the data but try to give them positive reinforcement you were trying it's a process you will learn it eventually it's a matter of continued learning and try to encourage them to keep doing it some people when you give them negative feedback they feel very bad they say well I cannot even learn this I'm going to fail they try to be very sensitive of how they can address the feedback and information but it's part of the session to give them feedback of how they perform and of course if they did modify the frequencies in the direction we want this is a big big positive feedback and encourage them to keep learning and we will talk this afternoon about what you do around the session how you need to keep progress how you need to keep your nose how you need to continue the relationship with the patient and all that that is very important during the session thank you very much a couple of things that brought to mind prior to getting into this profession I was a dialysis clinic social worker and it was impressive to learn about clients or patients rather that after a transplant would develop an affinity that the donor gave or provided so an affinity for peanut butter all of a sudden after their surgery and they come to learn that the donor had an affinity for peanut butter an affinity for chess and they never played chess in their entire lives but after they got this organ so all that to say that there's more and more evidence becoming apparent that we hold memories not just in the brain but throughout the body and so doing the bio feedback so that it doesn't hijack the brain is so important it's been important for me I'd like to tell clients, my own clients a simple way to describe it and I'm relatively new to this field versus some of the top brains here about three years but maybe I can bridge the gap between the general public and the more experienced folks I'd like to tell my clients that it takes about this much energy or this much yeah, this much energy for you to get through your day successfully but if you're using this much energy to hold some of the tension, some of the distractions or coping skills that you're not fully aware of then you've got this much energy to deal with this much day and it just doesn't add up so doing these types of exercises and making this a bit less where we're not coping unconsciously or maybe even legends in our own minds about what it is we're doing towards solving something but all we're actually doing is creating tension that it just broadens your horizons it's a beautiful thing I hope you enjoy your lunch we'll need to be back here promptly at one purchase the lunch we have them available for $15 for your convenience it's also kind of a donation to the organization they're available by the food area and so please enjoy and we'll see you promptly at one