 I think we have a great lineup of presentations today for you. We're excited that we were able to get this done. Angelica Seder is a clinical psychologist. She practices biofeedback and neurofeedback in Valley Forge, Pennsylvania. She also consults with other practitioners regarding practice development and patient care. So be sure to get her contact information. Together with Diana and each of their husbands, they have partnered with HBIMED to develop Brain ARC America, an EEG and ERP report service. Diana Martinez is a medical doctor, specialized in neurological rehabilitation and has been using bio and neurofeedback as integrative tools for her patients. She completed her PhD in neuroscience, studying the effects of neurofeedback and epilepsy. She runs a private practice in Boston, collaborating with Bessel Vendorkel. She is president-delect of the Mexican Society of Bio and Neurofeedback. Join with me, please, in giving them a nice round of applause. Well, thank you for coming. Good morning, everybody. We're on Easter in time, so it's late for us, early for you, so we'll kind of ease into it. Thank you so much for coming. And we want to thank all of the folks that helped to bring us here with the Texas Biofeedback Society, kind of was a surprise phone call, and that's how things often go, I think. One thing led to another, and ARC made a bunch of arrangements, and the board quite pitched in with him. We're very appreciative. It's very nice to be here, and we've already met a bunch of folks that have been very fulfilling for us already, so we're looking forward to getting to know you all as the day goes on. Especially, I hear there's students here, and that's something that's like the most exciting thing of the whole day. So the students, would the students raise their hand? I hate, I embarrass students, but that's probably the best I've ever seen percentage-wise. Wonderful. We need you guys. This field is a field of people who are a little bit older, and we need a lot of the folks that are a little bit younger, coming in with new ideas, coming in with a lot of enthusiasm. So it's absolutely wonderful to have you here. You guys have a Facebook page, man. That should be on the Facebook. You students, Facebook, Facebook, do whatever you do, Twitter, I don't care. Get it out there. This is where I was, and you weren't. Make it known. Thank you. Yes, well, I feel very lucky to be here. It's really an honor being in a society with a long history that I was learning yesterday, and with all these pioneers in the area. And it's really an honor to be speaking with you and with all the background that you have as a society. Also, it's very enthusiastic for me to be in a university campus where they have an aerial feedback program, right? That this is our goal internationally to get more programs, academical programs, and education tools for you guys. So it's really great to be here. And hopefully, you enjoyed the day. We'll try to share as much as we can and help in all levels. But thank you very much. This is about an eight-hour presentation condensed into one hour. So we're going to roll with it really fast. This is an APA-required slide. And I am required to read it for American Psychological Association, CE, if we don't have this, we fail. So here we go. Don't work beyond the scope of your capabilities, please. And if you're licensed, you have to abide by the law. And just as this slide says, stay within your professional standard. We appreciate that. A little bit about myself. As we see with the students, you guys are going through the direct funnel into biofeedback and neurofeedback with people that have been in the field for a long time, not so much the case. I did my graduate work at the University of Dayton in Ohio. And that was in clinical psychology. From there, I went to University of Nebraska. And if anybody knows anything about Nebraska, I don't know, Texas only cares about Texas is what they hear outside of Texas. But there is Nebraska. And when you're in Nebraska, that's what it looks like. I don't know that much about football, but that's Nebraska. I went from there and worked in a state hospital, worked in the geriatric facility, a large state facility. And there was a time when state hospitals back in the days of JFA, where money was being poured into mental health, we had beautiful facilities. And actually, this is what the same facility looks like now. It's really gone to decay. And I don't know what they're doing with it. Following that, I was partnered with my husband and he ran a inpatient facility at a maximum security penitentiary. And I did the administrative side of that. So we've kind of a real circuitous route. He was at the state penitentiary for 14 years. And that does take its toll on everybody that works there or is there. And he kind of decided to leave and do something entirely different, entirely new. And that's how he got involved in neurofeedback. He took a course with, oh God, at that time it was Sue Offmer, trained him. And he came back home and said, I think I'm gonna do this. And I go, okay, good. But I have to buy some equipment. Okay, how much? $12,000. Like what? Like the most they ever bought was a Wexler test for $500. And he's talking 12,000. Prices have come down. But that's kind of where things were before. He got involved in it and started seeing some of my patients that I had been working with for a long time. Those long-term patients that, you know, well, they come in for support maybe every other week, maybe once a month. And you do the best to help them but their life is gonna continue to be hard. So I had some of those patients and said, hey, I've been doing this thing. Would you like to try it? And that's what happened. In fact, that would have been like in, oh, 1998, 2000. You kind of experimented. You took people that were willing to do it. You took your family. You sat them down and you tried it. And so we tried it on these patients. We tried it. All of a sudden, they're not coming in every other week. They're not coming in once a month. The first person that we trained is our strongest proponent. She will talk to anybody about it. She ended up bringing in her daughter, her husband. And that's how it goes. So then we trained with EEG Spectrum, went back to the office, trained with them a little bit. And just at that point, you just kind of start to get to know people in the field and you train all over the place. And actually when I met Diana, we were presenting separately at a conference in Mexico and didn't know each other. After the conference, Diana called me and said, I'm in Philadelphia. Well, that's where I am. We're like, what? And I met you in Mexico, so we ended up doing some work together. But also at that conference, I met Andreas Muhlen, who is one of the founders of HBI Med, works with Yuri Kropotov to develop the HBI database. Turns out Andreas is from Switzerland, or from Switzerland, I'm from Southern Germany. And so he spent the whole three days speaking German and talking about Switzerland and so forth. By the time we got done, he said, you'll come visit me. Yeah, I'll come visit you someday. Well, as it turned out, we did go visit him. And we visited him because we were going to take an op-mer course. And he took me and he said, you're not taking an op-mer course, you're taking a Yuri Kropotov course. So we spent four days with Yuri Kropotov and left with our head spinning. And that just changed the way we worked. That kind of, the whole story of how things go and it's never a straight path. So we want to keep the students on a straight path. You know what, I'm going somewhere else. Yeah, a little bit about my background. And also I didn't have a straight path, by the way, always finding the way and finding the right people in the right moment. So this picture kind of summarized how I got into the field. I don't know most of you know this guy, Barry Sturman. Barry Sturman, we consider him, well, the first researcher that found the clinical applications in medical conditions of neurofeedback. So we were there. I'm happy I have the date here, so I can remember because I talked about the date. So this was a meeting in Mexico where I met Angelica. This is Denise Malkowitz, a epileptologist, a neurologist, a epileptologist. At the moment I was doing a fellowship in neurological rehab, integrating different interventions to help recover brain injury. And I was working with Denise and of course all these severe conditions always have, most of the times have, seizures. And we were thinking if we could only find a non-pharmacological intervention that helps to reduce seizures, we could really help these patients to improve faster. So we were looking around and what other than drugs for epilepsy, and there's not much. So we learned about neurofeedback. We start understanding it better. We got in contact with Barry, invited us to various meetings. We learned, we started applying it in very resistant epilepsy. And we were really surprised. And we couldn't believe it. We said we need to understand more and more. We start learning and getting more into the meetings and training. Of course we always use EEG, QEG to evaluate the epileptic condition. And it was my interest to continue my PhD and to focus my PhD in studying the effects of neurofeedback in epilepsy. So I did this for almost seven years. Just testing what happened with epilepsy children. So finally I got my degree. In the meantime I was able, very happy to collaborate in Mexico. I was able to open two clinics in Mexico, neurofeedback, biofeedback clinics, leaving from Boston. So that was a challenge but always with a lot of interest in helping my country and go back and bring what I learned. And just recently I opened a private practice in collaboration with the Solvander Koch. I got into the, from epilepsy, I got into the trauma spectrum quite different that I will talk a lot about it today. And we have a private practice that is called Bospedural Dynamics. So you will learn more about it but this was my pathway and very happy where I am and all the things that I learned. So I hope all you guys can learn from our pathway that I think will enrich your experience. Okay. Okay. So, starting off with the test of course. So, which of the following is considered efficacious? One of the problems that we have in our field is those that want to be doubters of biofeedback and neurofeedback will talk about efficacy. And we'll talk about it's not efficacious. And people are getting smarter and they're learning about how pharmaceutical companies do their research and don't publish research that doesn't support what they're wanting to promote. But we do have lots of studies and there's lots of places to look them up. And so the treatment of choice as most efficacious would be which? Basically we've got these are rated as efficacious and the one treatment that's rated as most efficacious is urinary incontinence. Uh-huh. The best rating, the best research, research supports it as good as anything. Okay. Other things are most efficacious but they haven't met the gold standard. And that's what organizations like ISNR are working on, AAPD, and by creating publications by having researches in the field. Again, I'm gonna be counting on the students who are future, we need to, we need to do research, we need to publish this. So is it evidence-based? Yes. Okay. Is it invasive? Not at all. Not at all. It's important for the public to know. I wanna pause a minute because I was of the impression that there were going to be members of the general public as well as professionals here this morning. Yeah, can we show a hand of who is not a professional in the field? Wonderful, wonderful. And that to me is the society, the Texas Society meeting their mission. Again, I don't know of an organization, certainly not the Northeast, which I'm the executive director of. I've been to organizations with the Mid-Atlantic. I'm very involved with the Biofeedback Society of Florida. This is the best showing there. So, kudos to you guys. So, not invasive. The old terminology is electrodes. People talk about electrodes personally. I try to stay away from that and call it sensors so that we convey it's not electrodes. People just think electrodes are putting something in. So, board certification, is it available? So, who's the typical patient that's gonna benefit from Biofeedback? I see a lot of people that want a more active role in their healthcare. They come in, they've studied it. How did you find us? All right, Google. Why didn't you Google something else? We're in the hub of the pharmaceutical industry. Pennsylvania is one of the points that connects New York and DC and Philadelphia, three major hubs. So, we're loaded with pharmaceutical companies. Big, big campuses. Most of my patients are people that work at pharmaceutical companies. Looking for an alternative. They're studying, they're out there, they're Googling, they're looking. They don't want surgery. A lot of my patients now come from pain physicians. You know, how about this? Before we do the surgery, before we do the implant, do you think you could see if you could help them all? Maybe we can avoid the implant. It's not most of the doctors, but they're starting to come around. And then there are those who need alternatives to medication. Failed treatment. We've tried all the anti-epileptic, nothing worked, I'm still having seizures, I need something. Trauma victims. I had a call the other day. A woman who is a trauma victim herself. Her path was that she became, I think she was in, she became an LPC. We had a treatment in WNLPC. But anyway, she got herself licensed, she started treating people. Now she's treating trauma patients and she's saying, all the therapy I've had, EMDR on top of it, I need neurofeedback. I need to come in and start to learn something else. I need to get rid of this for myself. And I'm looking forward to VN's presentation this afternoon. Complex cases, autism combined with ADHD. These are folks that we can help. Can we cure them? Let's not say that. Are we the only thing that they should be doing? Let's not say that. When we work with other therapies together, we get a synergistic response that really can be remarkable. We can see miracles happen. And then pain patients that develop the secondary anxiety that develop trauma as a result of the pain. So there are people that will say, well, it sounds like you're selling snake oil. You think you can do everything. Well, it's all in the brain. So all in the brain, all in the messages that's being sent to the body. So yes, we can cover a lot of things. So today we'll go over the history a little bit. Not much. You'll have access to the slides, right? If not, they're all on here. We can just pass them around actually. Or you can email me and I'll send them to you. But so we're gonna blast through history. I'm not gonna go through that too much. It's all written in the slide. And then we're gonna look at different modalities and we'll wrap up with how to run a heart rate variability session and an oral feedback session before lunch. So simply put, for my patients that don't know about Biofeedback, how do you explain it? I know for years, Siegfried Achmer used to talk about what's the elevator speech, okay? How do you condense this? And so what I say to people is you've taken your temperature. That measures a physiological response. And then you look at the thermometer and if it's 98.6, you kind of say, hmm, I guess I'm not sick, I'll go to school, I'll go to work. If it's 102, you say, hmm, I think I'll stay home or rest. If it's 105, you say, I think I'll go to the emergency room, okay? So you measured your physiology, you made a response and then you see how that response helps you. And then you measure again, simple. We do it all the time. That's a very delayed intervention, but nevertheless it's a biofeedback intervention. So now what we wanna do is show them how to manage their dysfunctional activity in just a simpler way. So we'll record it, okay? So there it is, you'll have this on your slide. So since we have such a mixed audience, I'm not gonna go over this in detail. We wanna get to showing you how to run the sessions. So the instrumentation feeds back information about physiological responses. And so what that says is if you want a second opinion, I'll ask my computer, okay? We want to give people power. We wanna teach them how to self-regulate. That's the exciting thing about this. Somebody comes in helpless and I'm gonna show you how to help yourself. And you're gonna leave here the master of how you feel. People don't know how they feel. We collect a lot of QEEG data. Biggest problem you have this, I assume, T3, T4. What I just say to people is I think this is a phenomenon of Western culture. Over 90% of the people that we measure have tension in here. And people will say, oh no, I don't, I'm relaxed. Yes, because that's what happens. We feel like we're relaxed and we're holding onto muscle tension, muscle activity. And we don't even know it. You can teach somebody that. That's a pretty big deal. So we want people to become skilled in self-regulation. We want them to become more resilient to the world around them. Just had a young girl in a 14-year-old and she was all upset that her mother brought her in because she felt like this means there's something wrong with me. We, the mother was worried the girl had more going on. The girl was adopted. So anyway, she was very well adjusted. But she was having a lot of stress. And the reason that she got brought into the office was because she's a swimmer and she was having anxiety at the swimming. It actually brought her in for peak performance for sports. But as we talked about it, of course, it's not just in sports, there's anxiety everywhere. And by the time we got her data analyzed, she had excess high beta. So maybe you didn't need a cue for that. She's adopted, she's in a private school. She's got a lot of pressure on her. She's 14 years old. She's thinking about where she's going to college. I did not know college existed when I was 14. And what I ended up talking with them about is it's not a problem with you, young lady. It's a problem with our society that is putting this pressure on you. So let's start to talk about how much time do you spend on electronics? And of course, she says a lot. Well, if a 14-year-old says a lot to me, that means more than two hours a day. And for her, it was five hours a day. All right, not related to school, just electronics for social activity. So basically the way we framed why she was coming in is society is hard. Society has a lot of pressure and our brains were not meant to do as much as society is asking us to do. So we're gonna work on truth and we're gonna work on getting that high beta reduced, but we also have to work on getting your life changed a little bit. So resilience to the effects of stress is what we're helping people learn. I ask all teenagers to voluntarily take a one-week hiatus from electronics, except for what's required at school. About 70% will do that and they come back and they're amazing at how nice it feels. I'm gonna try to throw in lots of things as we go along. Mari Swingles, who is Paul Swingles' daughter in Canada, has a delight, not a delightful, but a very good book. I was delighted when I was done of Reed. She's done a lot of research on electronics and internet addiction and the way electronics are changing our brains. And she's actually got hypotheses about how, what the biomarkers are for internet addiction. So we make ourselves more resilient to the effects of stress for those with pain. We're able to adjust our pain perception. People don't understand, pain patients don't understand while biofeedback, how's that gonna help me? The pain has changed your brain. At this point, your brain is hyper-sensitive to anything and so we'll work on reducing that and then we want to improve your mood stability overall. Early on, a lot of people will ask, well, I'm afraid of this. I don't wanna do any of this because it will change who I am. No, no, it's gonna let you do who you are. It's gonna let you access that. You're not gonna have the other junk in the way. History goes back to 1938. Do not let anybody tell you neurofeedback, biofeedback is new, baloney, it's not, it's older. It's older than pharmaceutical. It's older than the surgeries we use. It's been around a long time. So you've got that all. I'm not gonna read through that and give you the studies on that. Otherwise, you have to stay here till nine o'clock tonight. So I'm gonna let Deanna talk about Barry. She's got a nice, strong personal relationship with him and then we'll follow it up with the video. Okay. Yeah, I think of course all the pioneers and the names that you saw in the previous slide are very important for you to know and acknowledge them and understand what are the trajectory where they will learn from them. But I think somebody that you need to be very aware is Barry Sturman, most of you have heard about him, probably even the not clinicians know about him. But while Barry was really the person that helped us to learn more about the clinical applications and how we could train the brain in the neurofeedback procedure, how you can train the brain and modify physiology to improve certain symptoms. So the story is that Barry Sturman, he was a lead researcher in University of Los Angeles and he was studying doing basic research in animal models, in cats. So he was studying the different sleep patterns and sleep cycles in EEG in cats and understanding the different frequencies to the different cycles of the sleep and he was teaching us a lot about different frequencies and what they mean. He was hearing other authors that it was possible to train the brain to learn in a conditional way to produce certain frequencies. So he started doing this with cats. He took a bunch of cats with operant conditioning, start teaching them how to produce the rhythm that we know as SMR, the sensory model rhythm of 15 cats. So because we're there and as they produce SMR, they got the reward, right? That was something that they could eat. So the brain wanted to produce it more and it was very nice to say yes, an animal can learn to modify the brain activity with operant conditioning. So he was very interested about the finding but at the same time he got a grant from NASA and they requested him to test different doses of a epileptogenic field that the astronauts were exposed in the mission. So he said, well, I need a lot of cats because I need to use a different dosage of the field. So he took all his cats, put different dosage to find what was the dosage that caused seizures. So he found that something very strange, the same doses that he was applying to one cat, it was causing seizures but the other group didn't have seizures and he couldn't understand. It's the same dosage. What is wrong? Why some cat can't produce seizures on the other stuff? And he found that was only an egg dollar, was just by chance that he found that the group that didn't have seizures were the cats that were conditioning in the training to condition producing of the SMR rhythm. And that was the finding and he couldn't understand and finding more the neurophysiology of the SMR, there's something that protects the brain for epileptic seizures training SMR. So that was the finding, he was, this is very, very interesting. So he had a subject, a human subject with epilepsy and he started training SMR rhythm. And yes, it was very relevant to find out that the seizures dropped off. So there was a protective mechanism for seizure producing the training of the SMR. So that was a huge finding and from that his students and the people around started applying SMR training for other conditions, for attention, for depression and other conditions and this is what was the beginning of this. So it's very important for you to know these backgrounds and yeah, there's very, very good papers about it and the understanding of the neurophysiology basis of the SMR training. Okay. I was going to show a video, but I'm gonna switch up, I'm gonna say that for the end so that we have time to set up our equipment. Okay. For the demonstration. Okay. So we'll come back to that. Okay. So you're here as part of an organization and the organizations that are associated with Biofeedback are important. They can provide a good amount of support to patients, to practice, to students as you need resources. So the Biofeedback Certification Institute of America, BCIA, they're in Denver, is a, it's a small organization. It's two people. That work their buns off all the time. I'm on the east coast and I can call there at eight o'clock in the morning and get an answer. Makes me astounded every time, but it works every time. So they are the organization that grants certification. Basic Biofeedback Certification, I don't wanna say basic, I'm gonna say general Biofeedback Certification. So that covers a broad number of things and let's say it covers essentially everything except details on your own feedback, which is a separate certification. There's stress management, okay? That's the one that's the most efficacious, pelvic floor disorder. I think we have one person in the whole Philadelphia area that does pelvic floor disorder biofeedback training. And that's the area where it's probably the least spoken of all. It affects over 50% of females over 50 and as well as a very high number of men over 50. So as a specialty, is that part of the university program here by any chance? Yes, amazing, amazing. And then there's EEG Biofeedback Certification and BCIA is now adding a heart rate variability certification. It's still in the works. We're taking the test actually. I've delayed taking the test. Just can't get around to it, but a bunch of us are taking the test and then they're gonna extract from that test what the final test will be. All right, so I wanna talk about, not the way I wanna go, hold on. Okay, organizations, an international organization. They just, some of you went to that meeting. They just recently had their meeting, I guess a month ago. There's the Biofeedback Federation of Europe. These are all places you can go on the website. You can find lots of resources, AAPB has lots of resources and then of course, there are the regional organizations. So I didn't list them all. I just wanna give you some things that you can refer back to. So let's look at biofeedback modality. Temperature, we're gonna talk about that in a little bit, but basically uses a finger sensor to measure temperature. We use that all the time. We use it with everything. GSR is measuring skin response, it's measuring muscle contraction and we just had a patient that did, she was trained in a different clinic and then she came to our clinic and she probably done 30 sessions of neurofeedback, not getting better for headaches. And finally we said, let's get a QEEG on you and see what's going on. He's got muscle activity going on. And the story, she's training with GSR and she's been improving in her headaches, pronto. It's amazing. So these are things, initially I was not trained in, I originally got trained directly in neurofeedback and I kind of went backwards in my training and went back to the beginning where I should have started and I missed out on a lot in those first years. Heart rate variability is my personal favorite form of biofeedback. I hope by the end of the day today I can convert you all into using heart rate variability all the time, convincing everybody in your family to use it, convincing every child you know to use it, convince everybody in the world to use it and then there's brainwaving teaching. All right, we already talked about that and you can have a slide. So I have a bunch of stuff with me, my bag of toys and we'll pass this around. But temperature, thermal biofeedback is one of its early uses was for migraine headaches. Increase your blood flow, reducing migraine. And that still remains, my temperature sensors, that still remains one of the most effective treatments for migraine. There are other things that we'll talk about very soon that you can use as well. Be aware when you're measuring temperature, when you're measuring the thermal biofeedback, you're not measuring internal temperature. So sometimes people get freaked out and they're like, oh, my temperature is so low. We're not looking for 98.6 on this, okay? The most would be in the 90s. I don't know that I've ever gotten above 100, I don't know. Anybody ever? Yeah. Sometimes you get somebody like 97 and you're like, wow. Amazing. These are the nicest thermal sensors I've found, but I'm sorry to say you won't find them. They're not making them anymore. I've gone to every manufacturer and asked and get them for me and they can get them, but they're like $100, which is silly because you can buy other ones for $15. So the other ones just have like a little probe that you attach to your finger, but I'll pass these around, especially for those of you that haven't done it. And if there's anybody that does biofeedback and has not done this on yourself, please don't tell anybody. Don't do biofeedback training on others without having done it on yourself so that you know how it works and you know how you experience. You learn a lot from doing it on yourself. Like when my husband came back with his new EEG equipment, I'm very, very sensitive. I'm very responsive to EEG. I'm responsive to coffee. I'm responsive to alcohol. Makes sense. So he trained me downstairs in our basement and he trained me too low. And I could not move. 15 minutes of training too low, meaning he enhanced my low frequency. I was super relaxed. So super relaxed, I couldn't tell him. I couldn't move. It was remarkable. He was like, Ang, you okay? And I'm like, eventually he's gonna figure out I'm not, but I really don't care to tell him. I'm like, so relaxed, I don't care. I could stay here all night. So do it on yourself. It's a good experience and you can tell your patients about it. So I'll pass these around and do you all know how these work? Raise your hand if you know how it works and I'll look at who does it. I'm glad I brought them. So very easy. You just rest your thumb on it, okay? So right now, my temperature runs low. I'm like always the coldest person in the room. So I'm at 73.6. It's low, okay? As you become more relaxed, it should increase. Your blood flow increases, blood flow has warmth to it, and so the temperature should go up. So this is very easy to do while you're doing hypnosis, easy to do while you're doing heart rate variability training. We do it as a pre and post measure for neurofeedback training. And if you're trying to show somebody what is biofeedback, you just pull one of these out of your drawer and you're like, hey, let's demonstrate it. Right now, I'll show you. And here's the fun thing. I'm trying to distribute them around the room. Little kids, teenagers, understand biofeedback. If I start talking about biofeedback and I say, oh, I'm gonna show you a way that you can regulate the way your brain works. The adults are like, what do you mean? How are you gonna do that? Is it dangerous? All kinds of scary thoughts go in their head. Whereas the kids are like, what I'll do is I will say to the kids, tell your mom what we're gonna do. And the six-year-old can say, oh, what she said is she's gonna show me how to make my brain do different things so that I can do better when I'm in school. And I'll say to the kid, how are you gonna do that? How am I gonna show you that? And they're like, well, I don't know. You said you're gonna use a computer and the computer is going to have a game that changes, but I'll change with my brain. Easy, they get it, bam. And so show them the thermometer, the skin sensor, they'll look at it and they'll know exactly what they're doing and then let the kid teach the parents because they'll be able to show the parents how to do it. Raynode, it doesn't come up often because people don't talk about it because they don't think they can help it. So as part of your intake, ask people, it doesn't seem relevant, but I just wanna make sure you don't have Raynode. You'll be surprised how many people are gonna say, oh yeah, here. Hypertension, it's easy and people can learn it and they can do it at home. Why is not everybody in the world doing this? I don't know. EMG, I talked with that. I did not bring an EMG device, but again, it's very simple EMG. You're gonna put a few sensors on specified locations. If you have tension back here, okay? You can place the sensors in specified locations. They're going to read your muscle tension and as you relax or tighten up, you'll get an indicator. Usually it's a light and a sound indicator that will increase or decrease depending on your muscle tension. This is something people can use at home. I'll jump ahead at the end. I'm gonna talk about pricing. The EMG device is not that expensive to buy. You can buy it probably for a couple of hundred dollars. So it can be very readily applied to a practice. It can be used at home. Again, people don't know that they're even holding muscle tension. So this is a very easy way to show them what they're doing and patients are surprised for the time. Okay, heart rate variability training. I'll tell you how I got into heart rate variability training. My husband went to a conference and we had two little kids and I stayed home watching the little kids been working while he went to a conference in California and it was over my birthday. He came back and he brought my birthday present. And I brought your birthday present and it was obviously a disc. And I thought, man, I went to California and I'm getting a disc because it was perfect. I like music, but this is just not enough. I opened it up and it's a heart rate variability software disc. Now I'm even more mad. Like you're kidding me. You brought me something for work for my birthday? Okay, so we plug it in. Well, it turns out I'm very good at heart rate variability. Just lucky, just happened to be. And he's not. And so we had the computer all loaded up and I was the winner. I could do it very easily, but that intrigued me. And then I got to see how easy it is to teach because I started teaching him how to do it and how effective it is. At one point I was hired by the United States Tennis Association and I would train about 200 of their top junior players in heart rate variability as a way of managing their anxiety during competition. It can be used for all kinds of applications. There's a school in Pennsylvania School District that has a gain of all of their elementary schools and we taught all their teachers how to run sessions and the teachers have the children do heart rate variability training before tests. Their scores has increased dramatically. Pennsylvania is notoriously, I'm gonna say bad for requiring standardized tests. They do three weeks a year of standardized testing. So, at any rate, the kids are really pumping off good scores on it in that district. So what are we doing? You wear a sensor, it used to be on the finger, now they put them on the ears, but the sensor measures your, oh, simply, and with more sophisticated programs you can wear a respirator band. But essentially what we're doing without teaching you 20 hours of heart rate variability which it seems impossible that you could do that, but you could, it is very, very sophisticated in all of the physiological processes that happen. But in here you have a bariflex and that measures your blood pressure before your blood pressure actually changes. So we're measuring how the blood pressure, how the rhythms of the heart synchronize with your breathing. And so, have the students taken courses in HRV yet? Are they, is that part of the program? I'm so intrigued by the program. Nothing? Yeah, yeah, okay. So generally speaking, if you have low heart rate variability, if you're the rhythms of your breathing and your heart rhythms are not synchronized, you're gonna not feel well. You're gonna be prone to be more sick more of the time. Your lifespan will shorten. What we're doing is teaching people how to be physiologically and emotionally resilient. And what I wanna do today, again, is really intrigue you with this, fascinate you with this so that everybody in this room learns how to do this and incorporate it into their lives clinically and personally. So the sympathetic and the parasympathetic nervous system guide our lives and make us happy. Something happens, the sympathetic nervous system activates and then the parasympathetic nervous system quiets us down. Our sympathetic nervous system likes to be activated. It likes to protect us, it likes to keep us safe. And so we stay in a state of high activation. And in today's society, we don't allow many activities for the parasympathetic nervous system to kick in. I was with the young girl the other day and I wanted to leave my office to go get a device to show her something. My office is upstairs, I had to go downstairs to get to the device. And by the time I came back up there, she was texting. No relaxation. The brain, our society does not allow our brains to relax. It doesn't allow our parasympathetic nervous system to kick in. So now we have to find ways to make that happen. So when sympathetic nervous system is in balance, wonderful things happen. We can reduce hypertension, improve asthma. Why is not every doctor's office in the country that's treating asthma, sitting, those people aside and saying, learn how to do this? If we can reduce 50% of it, that's a wonderful thing for a child that has asthma. It increases calmness and well-being, it makes us more emotionally stable. It's just the best thing ever. Improves performance, improves the way we think. It improves our ability to process. It increases our reaction time, increases our ability to learn. You have all of these slides again. So there's just a slide that shows you all of the physiological stuff. I have a better slide coming up so I'm gonna skip that one. HeartMath is a company that does a lot with heart rate variability. We're gonna use their program in a little bit. I'll pull that up to show you how that runs. They have a very simple process, very easy to use to interface, and what they're looking for is something, they term coherence, term they've created, but it has to do with desynchronization of the system and they actually have a guide that teaches you. So I'll pull that up later and show you. But I want to tell you about different types of software. HeartMath makes the software. They also make a handheld called Interbalance. The app is free, but you have to buy a sensor. And the sensor, now they even have a Bluetooth sensor so the slides aren't entirely up to date. I think it's about $150. There used to be a company called The Journey to the Wild Divine and they sold to another company. They sold to a bunch of, the two I know are in Canada. One of them was just an entrepreneur and the other one was somebody who had a background in physiology. So they bought this program and they created a new company called Unite. And I have that here to show you. But it's got many, many, many different forms of programs that'll take you through meditations and heart rate variability. So this is something that you can buy online. You can buy it by the year. You buy it about, I don't know. I'm gonna say it's like $120. In fact, I have coupon codes. So if you look at it and you want to buy it, you mail me and I'll send you a coupon code and it's getting a little cheaper. But you get a little sensor and a little device and you plug it into your computer. This is the whole thing and everything's online. And thought technology makes a very nice program. It's a little more sophisticated, a little more expensive. If you're doing things for research purposes, that's gonna be your go-to program. There are also Nexus, oh, I did put it on there, okay. Nexus has a nice program as well. Those are equipment manufacturers. So for those of you that are in the field, you probably know them. For those of you that are new in the field, you can look further from there. There's lots of breathing apps. And now, oh, people will say to you, I have it on my watch here. I have high variability and I measure my sleep. I know how much I sleep. You don't really know how much you sleep. You know how much you need. That's what it's measuring. It's not measuring brain. But it's giving you a nice indication. And we're gonna see more and more of these devices. There's a lot of startup companies working on these things. Neurofeedback, I'm gonna switch over to Deanna. Going to Neurofeedback a little bit. We're blasting through this, okay, because we have a wide range in the audience. And you'll have to quickly, you gotta use it. Yes, and just to mention something about heart rate variability. JS is a very easy technique. It's a very easy to teach. And probably if you don't have a lot of budget to begin using these tools, probably HRB is the best to begin with. But considering that it's simple and easy, it has their complexity to understand the physiology, the cardiovascular physiology and respiratory physiology to properly teach a patient or a person to breathe, okay? And yeah, I will recommend you to have some reading and understanding very well why it needs to be certain amount of time inhalation, why certain amount of time exhalation. We're going to do a demo session because many of these things, if you don't know how to teach them properly, you can actually teach them how to over breathe or are hyperventilate, that you can make worse the symptoms. So it has a very simple, technology is very simple, but you need to understand broadly how to teach a person to breathe properly. So but yeah, it's definitely very useful and very friendly. And well, neurofeedback, most of you are aware of it. And well, neurofeedback is the process to learn to self-regulate the brain activities. And we know and we have researched to back us up to understand that modifying specific brain waves in the specific regions of the brain, it can help to reduce the symptoms and improve the situation with the patient. Ideally, I come from my background is very strong in having EG, QEG, neurophysiological assessment to prescribe a neurofeedback protocol. I know many people in the field don't necessarily use it. We understand it's expensive. You need to have a lot of training and understanding of the technique. And we will talk about it more, but the more that we learn, the more we understand we need a very strong neurophysiological assessment before we do a brain training, right? Before, even when I started in neurofeedback, we were like, oh, well, neurofeedback is super safe. It's not invasive. The worst that can happen is nothing bad will happen to the person, right? This is the worst. Now we've learned that no, we can actually cause severe side effects. We can increase the symptoms. We can really affect the patient. So we really need to understand what is going on in this brain and in a deep level. And we have all the clinical scales and all the clinical information you can integrate, but you need to have a map of what is going on. And it's not that we use just the QED to prescribe a protocol. It's a puzzle of information, right? You need to have the more resources, the more information you gather, the more appropriate is going to be your protocol and the more effective and successful is going to be your intervention. So if we're talking about short-term protocols, the client, the patient is not available for a long-term intervention or they are only coming to you for a certain period of time, you need to be very precise of what you are doing, right? Or it's very difficult to condition this person really needs help right away. You cannot wait 20 sessions and see what happens. You need to be very precise. So definitely QED, ERPs, all these neurophysiological and levels of information will help you to be more precise, more effective and prevent side effects. But well, you will see other people do different things, but this is what I would recommend. And well, this is the 1020 system. This is our language for clinicians to understand where we're going to locate the electrodes, where in the brain, what are the relationship between where we put the electrode with the function of the structure of the brain. So there is a reason why we put the electrodes in the brain, right? And if you're a client, if you're a patient, you want to understand, well, they are training me here in the frontal lobe, why? Why is the purpose of my frontal lobe and what are my symptoms related that are in the frontal lobe? Or why they are putting the parietal lobe or in the temporal lobe? So this is the location and we have to be very precise where we're training, what is the purpose of the protocol? And these are the different bands that we train. We use this terminology, delta, theta, alpha, beta. So for the clients, if you've heard these words, this is when we are referring of different frequencies bands that our brain is working in different mental states and is related basically to mental states or of course related to symptoms. It's more appropriate to talk about the frequency range instead of just using the word of the band. It's more appropriate to use, I'm going to train you seven to 10 hertz or 12 to 15 hertz. So you are very precise on what you are training. But this is very important for a patient and a client to understand what are the frequency ranges? What is their goal of the training? When is prescribed or when is recommended neurofeedback? Well, most of the people that look for neurofeedback is because they don't want, they are looking for a non-pharmacological intervention. They have been taking drugs for many years. They are not finding the help that is needed and they have severe side effects. So this is the main, most of the times they are looking for a non-pharmacological intervention. They also feel stuck with psychotherapy or other therapy. We call neurofeedback as a tool to help them to be unstuck and keep going with therapy. We never recommend neurofeedback instead of psychotherapy, okay? Neurofeedback needs to be an integration with other interventions but we will help them to move forward. Many clients come and say, well, I've been doing psychotherapy for 10 years and I'm still in the same position. So neurofeedback will help them to move forward and we'll talk more about it because it's very interesting to see what is happening during neurofeedback that is helping the patient to be in a more, in a better surface, in a better position to be able to talk about what they have to deal with, what they have to deal with. When it's a main brain problem also, I mean, if the main symptoms are in the brain, of course we need to train the brain. There is people that just prefer this method, right? I'm very happy with the moment that we are living. We opened a clinic six years ago in Mexico where our situation at the moment was really to not only educate the population and the patients but also the medical community. They didn't understand about biofeedback, neurofeedback, even that I brought all the research and all the data, they are not aware. So if they don't know about the technique it's very hard for them to refer the patients to this method. So it was really a lot of education work. Right now I think we are in a different moment. Right now medical community, other professionals are more aware about it, they are curious about it, they want to learn and they are more open to refer clients. And when they see that their patient is getting better of course they are happy to refer more. Now in Boston I'm really impressed in the position we are. Psychiatrists are really looking into us. They know that drugs are not solving a lot and they are desperate to find neurochemical intervention. So we are constantly now getting referral for psychiatrists, neurologists and they are very happy to see the help that we can provide. So you are very lucky the student that you will hopefully apply this in another level of understanding for other professions. And hopefully well another story is about insurance company, right? Okay, Peg. Now 24 year old nephew failed out of college twice. He has left his job twice and that's not a surprise. When he was four years old we knew he was dysregulated. So finally, you know the old story of you never profit in your own town or your own family, my brother calls me up and says let's start out, we'll take a map, we'll take a brain map. He came up to visit us and his standard deviation in some of the measurements was 10 standard deviations from the others. That's big. So okay, let's get him started on your own feedback right away. So I call up Susan Antelope on Long Island and say I really need a favor, I need you to see my nephew. So she sees him and after a few weeks I check in with my nephew, how's it going? How do you like it? He says I like it, I like seeing the movies. I'm like what movie, what do you mean movie? Why is she doing movies? I call her up and I'm like Susan, you jumped him right to movies because there is a thing about when we're training the brain we don't want to entertain the brain we want to train the brain. So she says, well you know I'm doing Jeff Kerman's HEG. I could have pulled my head off. I was like what do you mean? I send him to you for neurofeedback, you're doing HEG, why are you doing that? And she says Angela, I start everybody with HEG and I don't know why you don't either. Susan's a New Yorker, I'm a New Yorker and she and I get along fine. And so I started to look into HEG and I went up and I took Jeff's Kerman's course and I said, boy, thank God for Susan and Angela. HEG is a very simple program to use. Jeff is a psychologist who was originally trained in neurofeedback, got involved with Herschel Tuman and started to develop his own HEG system. What is it? Passive infrared chemoencephalography measures via an infrared sensor that's placed on your forehead, the blood flow to your prefrontal lobe. When your neurons are activated, as a result, you create excess blood flow, blood's the coolant. So when your frontal lobes are activated ostensibly, your parietal lobes have to quiet down. So the old adage of don't make an important decision when you're emotional, there you go. Okay, so engage your frontal lobes, disengage your parietal lobes and then make a good decision. And this is, again, it's very simple to learn how to do this. It's very simple to train to do it. My first experience was I trained myself on a Saturday evening and I, once again, when am I gonna learn? I couldn't do anything else. I'm by myself, I work in a business campus, I'm downstairs, the whole place is dark and I can't leave. And I'm wondering if I'm gonna sleep in that office that night because I am too relaxed. Now my husband's experienced, he over-trains himself and he was nasty. Frontal lobes are disengaged, you're gonna get disinhibited and he was nasty. So it's a simple to learn process, but again, the physiology of it is complex. So work within the scope of what your knowledge base is and practice on yourself before you start practicing on other people so that you can understand what it means to do it wrong. But basically you sit and do a baseline measurement with the sensor, measures your blood flow, you put on a movie and you need to maintain that blood flow in order to keep the movie. If your frontal lobes become disengaged, the movie will stop, there's a bar on the side of the screen that's going to show you and you need to elevate that bar again in order to start the movie again. And that's the simple procedure but not the simple process that's happening. Jeff developed this for migraines. This is our go-to thing for migraines. Somebody comes in migraines. No EEG, no QEEG. If the initial assessment doesn't show anything that would warrant that, we're gonna put you right on this. Now on the other hand, somebody comes in for migraines and their father has seizure? Uh-uh. Okay, we're gonna be a little more careful with you but it's Jeff's theory is if they don't respond with migraines in five sessions, you gotta look for it's not a migraine, it's diagnostic. But if you're improving frontal lobe functioning, you're improving organization, you're improving planning, you're improving emotional volatility. This combined with neurofeedback, combined with therapy, combined with other modalities can be very impressive. So here we have my husband, Jeff has and other people do now too, prices have come down, infrared cameras. So here's his frontal lobe. Before training and then after. 20 minutes of training. Something to know about, something to be intrigued with. Autism can be very, it can be helped with it. Is it the only thing you wanna do for autism? No, but we get all of the autistic kids on this training. Bioacoustical utilization device. Sorry, I'm blasting through, but there's so much to tell you. Anybody know about this? The bod is passed around. It uses down to change vibrational pattern physiologically. So the way I explain this to clients is think about the opera lady who sings and she cracks the glass. That's really quantum physics, the vibrational pattern of her vocal cords is interfering with the vibrational pattern of the crystal glass and it shatters the vibrational pattern of the glass. So with this, if you think of an emotional state that you have that you don't want to have or pain, you access that emotional state. It is the only time where I want somebody to feel more of what they wanna get rid of. Access that emotional state and then you tune in with what they call the pitch device. Let's see if I can put it on there. Okay, so you set the volume, left to your right ear and then you access your emotional state, tune in with the pitch and once you have that access, then this is a disruptor button. So then you tune in to disrupt the pitch. Musicians can relate to this very well. So if I know I'm working with somebody that has any interest in music, maybe I met somebody last night that does, he might be able to demonstrate it or try it and let us know over lunch how he likes it. But I'll pass this around, you can't hurt yourself with it. It, can you hear that? Okay, not a great sound. Some autistic kids don't like it. They don't like that sound. Don't even have a thing to do it. But you turn that on and then, is this gonna mess up if I put this to the microphone for the, for what you're doing back there? No good. Oh, it's good, okay. Okay, so we've got this. I practiced this for the first time. My brother's very annoying. He's eight years younger than me and he's still very annoying. And I was going to my mother's birthday party. I was driving, I was riding in the car and I said, let me try this and see how it works. He's gonna annoy me sometimes today. So I'm gonna access that feeling I have when he annoys me. I have said to him, nobody talks to me like you. Like, I don't understand why you still talk to me like this. But, so I access that feeling. So here we go. I get my volume level set. You hear, you hear the different sound? Okay. So I try to match that sound to what I'm feeling. If I match it means you feel that feeling more intensely. So I've matched it and now I'm gonna disrupt it. You hear the second sound in there? After find my pitch, I disrupt it. And then you sit with that for about 20 minutes. Got to the birthday party. And the first thing my brother says to me is, you're 20 minutes late, we eat, it's dessert time. And I was like, fine, okay. No feeling, no response, no anger, nothing. I was like, fine, let me sit down. So it disrupts the electrical field through sound. This was originally designed by a musician, hence the name. Interactive metronome, musicians, especially when they're playing collaboratively, the most important thing is everybody's got to be together. A millisecond off is not good. So the guy who developed it was a musician and it uses a headphone where you hear sound. It's just the bell, ding, ding, ding, ding. And then you have to execute physical activities in unison with the bell. So you wear a sensor on your hand and you're ding, ding, ding. Now, you build up to doing like a thousand repetitions of that. You do that for a half hour. But you're getting feedback. You're getting visual feedback about are you with the bell? Are you with ahead of the bell? Or are you behind the bell? And you get auditory feedback. So if I'm ahead of the bell, I'm like, ding, ding, ding, ding, ding, ding, ding, ding, ding. Till I drink, drink, I get the bell and my feedback together. Or if I'm late, ding, ding, ding, ding, ding, ding, ding. And there's my feedback. And there's different gradations of the sound and the visual feedback. With practice, you can get very good at it. And what you're doing, what they report that you're doing is you're enhancing the myelination of the neuron. And with the myelination, of course, the information travels better and then you're able to perform better. We've used this with professional tennis players all the way down to kids with autism. It gives a way of understanding, am I paying attention or not? It's very different from anything else I've seen. So, developed by a musician, he had a friend that was a psychologist that had a kid was developmentally delayed and they were teaching the kids a piano so they decided to do this with the kids and the kids started to improve. He improved his academics, he improved in his coordination, he improved his balance. So that led to a lot of research development. And this is now, I think, because of financial considerations, they figured out that this works very well as occupational therapist for rehab purposes but there's no reason we can't be using it either. It works very well for attention. We've used it as stroke victims for balance and that way we're working on the brain improvements as well as the balance improvement. Okay, so we need to take a break. Yes. Just to wrap up that part. This is just a brief summary of all the biofeedback techniques and fortunately or unfortunately, there are many people developing more tools and more devices and more things available for us to help patients, right? But I really encourage all of you to understand the basics, right? You need to learn the physiology, you need to understand the mechanisms and every time you see a device, just don't buy it because it looks nice and the seller is telling you you are going to cure everything. You really need to understand what is the purpose, how it was built up, what it works, why is the mechanism, okay? This is our responsibility. We know people want to sell the devices and we are eager and we are desperate to help people. So this is our weakness. So they trap us there and then we go very enthusiastic but we really want to upgrade the discipline, the credibility and the level of these techniques is our responsibility to understand the mechanisms or the physiology and the devices. There are many devices that they are black boxes, they wouldn't tell you what they do, they wouldn't tell you why they build it, right? But they tell you all the good things they would do, right? So be smart there, ask the questions, ask for the research. They have to have good amount of research for you to apply it. And once you have it yourself, if you decided to go with that, really try it yourself and with people close to you, don't go straight to the clients and the patients and be very wise in how you are going to apply it. The last lecture today, we're going to talk about how to make a successful practice and we will talk a lot about it but I just want to give this comment before, if somebody is going to leave before lunch. So be very, very wise in understanding mechanisms, physiology and the devices and try to do your best to understand it. Okay. So we're ready. Let's give him a round of applause. Thank you very much. I remember when I first started training at this university with Dr. Jones and one of the things that was said was he used to say, well, once we pick a protocol, we've got to pick the site, clean it, and then abrade it. And then Shanda, one of his students, one of his shining students said, Dr. Jones, we don't abrade, we exfoliate. Got to spy it up a little bit. So it reminded me of what you said about sensors instead of electrodes. Folks, there's plenty of food left from breakfast. We're running a little bit behind with so much information, great information. Please help yourself to any of the breakfast items that are still available. And for the sake of time, instead of a 15 minute break, let's try to do, let's be back at 10, 30, I'm sorry, 10, 40, 10 minutes. We'll make it up for you. We're gonna make some time up with the next presentation. Thank you all.