 So, yeah, my name is Stephen Jones. Good evening. I'm a psychologist and my education also a sports scientist and I currently work as a neurofeedback therapist in medical practice here in the center of Munich. As the word neurofeedback would imply, we're working with processes within the brain that we're trying to influence in a positive way by generating feedback about them to improve certain the brain's regulation, the brain's self-regulation. So, first question, by a show of hands, how many of you have heard of neurofeedback? That's quite a few. That's good. That's sort of what I was expecting, about almost maybe 60-40%. So, let's go and take a look at what it actually is. Very simply put, it's an EEG technique for training the regulation of unconscious activities in the brain. So, what we do is we place electrodes on the scalp. As you can see, our volunteer has one on the back of his head here. You can't see them so well from there. And we measure the electrical activity that goes on on the top layer of our brain, which is sent through an amplifier to a screen that you can see over there. And we basically see the EEG, which is, first of all, a bunch of lines. And we try and generate feedback about this activity. So, the most basic form would be to say, okay, we show the person the lines and say, improve them. That won't work very well, though. So, what we use is music, videos, or games that are based on a threshold and react to the activity. So, every time a certain activity goes below the threshold, sorry, above the threshold, we reward our client or our patient. For example, by the music getting louder or the video, as in this example, getting bigger. And every time it's below the threshold, the music will get quieter and smaller. So, we're rewarding positive behavior in the brain, basically. You may have heard of operant conditioning. I'm not going to go into detail, but it's based on that. So, why do we think this is important? Why do we do it? Here, you can see the number of lost working days per 100 employees over the last 20 years. And you can see it's tripled over 20 years. And we do suspect that there's a much larger dark figure, obviously because people don't like to talk about psychological problems, as it's often seen as a weakness, unfortunately. And so, we also see people who come to us and won't tell us what's wrong with them. I don't want to have neurofeedback training, but three or four weeks later, they'll start opening up and telling us about problems they may have. So, that's why we suspect that these numbers aren't quite accurate. So, that's why we believe we need to find a way to interact with the brain rather than just handing out pills that help with the symptoms but don't actually solve the problem. So, can neurofeedback solve the problem? Well, it's not a magical cure. It's been around for half a century and it hasn't managed to break through completely yet. But it is a very useful tool in treating the symptoms severity, treating comorbid symptoms, and also for improving the quality of life and general well-being. I mean, we all go to the gym because we know physical activity is going to make us feel better, it's going to make us more healthy, it's probably going to have longer lives and we're going to prevent certain issues when we're older. So, why don't we do the same for the brain? And that's pretty much what we're trying to do here. We're trying to train the brain to have a more healthy regulation. So, let's go into a bit more detail of how it works. This is an EEG. You may have seen this if you've ever visited a neurologist. There are 19 channels here. There are 19 different points on our head. And as you can see, at the same time, we have different types of activity depending on the location. And it's when these patterns fall out of balance, the symptoms start to occur. So, let's just go and have a look exactly what we're measuring here, what these lines actually mean in the brain. So, this is a neuron. And we have the line underneath is a so-called action potential. Some of you may have heard of this in school. You may remember it from biology classes. A neuron has a resting potential of minus 70 microvolts. And when there's a certain exchange in positively and negatively charged molecules, what happens is an action potential is created. That means that the cell suddenly depolarizes and you get sort of a line like this if you measure it with one electrode. Anyway, it's just a picture of a cell basically. So, we have positively charged molecules, negatively charged molecules inside and outside the cell. They're constantly changing and for whatever reason, the sudden increase within the cell, or outside the cell and then you see this action potential. That's basically what we're measuring. So, we'll skip that slide. So, we go back to the brain waves. We work with two features in your feedback on EEG generally, I guess. We have the amplitude, which is the height of the brain wave, measured in microvolts. And that represents the strength. So, the number of neurons doing exactly the same thing at the same time on a certain location. And we have the frequency which we work with, which is the speed of the brain waves. So, that's measured in hertz. It's the number of cycles per second. And based on the frequency, we can separate or divide the raw EEG into frequency bands, as you can see here. So, you can see at the bottom we have the delta activity which are slower waves and larger amplitudes. This is something that we measure predominantly when we're asleep. And for example, if we're sort of concentrating, working hard on an exam or just work focused very strongly, we have lots of high-better waves, the faster ones with a smaller amplitude. And that's a good thing. We need these brain waves for different mental states that we're in. It's just when we have the certain frequencies at the wrong location, I guess, or a location that we don't want to see them over a long period of time when we have problems. But just to make this whole thing a little bit more clear, this is why I've hooked up our volunteer here, is to go into a quick demonstration. So, this is what you're going to see in a second. I'll just have to walk over here to change a few things. But I'll just show you over here right now. So, here you can see, well, this white line is the raw EEG, all the frequencies are contained in here. We've filtered out the alpha. You'll see why in a second for demonstration purposes. And that's the alpha amplitude it represents. And here we also have the alpha amplitude. Now, we want to report the alpha activity every time it goes above a certain threshold, which is here, this little arrow. I don't know if you can't see it as well. There's a small arrow here. Every time the brain activity goes above the alpha, this number here, which is the percentage of time above threshold, will go up. And the case of the game that I'm going to show you in a second, the monk will also react to it. So, I'll just switch screens quickly to walk around. So, this would be the game. So, you can see the monk's going sort of quite low right now, but he's going up and down a little bit. And that's the reaction to his brain activity. So, I ask our volunteer now to close your eyes for a couple of seconds. Now, you can see the monk rising up very quickly. And that's the alpha activity suddenly shooting up. It's a healthy, normal reaction to when we close our eyes. So, that's good. So, we go back to the screen here. So, you close your eyes one more time. Yeah, you can see the alpha shooting up the top of the thermometer now. Yeah, so that's basically what we work with. And over time, the brain learns to adopt this pattern in everyday life. So, back to the brain waves. It's very simplified, but it gives sort of a rough idea of how it works. The slower waves are present or dominant when we're more calm. And the faster ones, as we get more stressed or more focused or concentrated on things. It's important though to understand that all these frequencies happen parallel. There's no good waves or bad waves. They're all happening at the same time. And it's the dominance that varies. What we tend to see a very concrete example would be burnout. When people suffer burnout, often it's work related. And they're working their 12-hour days, 6 days a week, week after week, month after month. So, they're using the front part of the brains and generating a lot of this high beta activity, which they need. But if it's constantly there, the brain starts to make that the new normal regulation. So, they're not able to switch off anymore and relax. So, with those people, we try and turn things around or teach them, train them to be able to switch off their brain waves and to control and regulate their brain waves more consciously. This is an example of one of our patients. Ah, something's happened here. Okay, it's supposed to be delta theta alpha beta gamma. This is typical for depression. This is a so-called quantitative EEG. It's a resting EEG of a whole brain of the 19 electrodes or 19 points that I showed you earlier. And we compare the EEG to a large database. And it sort of shows you, compared to the database, how many standard deviations or how do you compare to what we'd expect in a healthy person of that age and that gender. So, red means we have too much of something compared to what we'd expect. And blue is too little. So, here we see lots of too much theta, too much alpha and too much beta, particularly in the frontal areas. And that would suggest the theta is associated with anxiety, for example. Alpha is associated with the frontal areas with lack of focus, lack of concentration. And the high beta would be constant stress, basically, or circling thoughts, which we see in depression. So, with this person, we did about two months of training. He asked if we could do another quantity of EEG, which we don't always do. We're trying to do more and more now to generate more evidence for what we do. And we saw something like this. SMR training, that just basically means that we're training the theta down whilst we're training some more relaxing frequencies up. I'm not going to go into detail on this, but we're basically training theta down and we'd also add an alpha training as well. So, we'd train the alpha down in the frontal areas and then you end up with a picture like this at the bottom. So, there's a great improvement here. And this often matches what the people are telling us as well when they come and see us. After certain... Well, surprisingly, it doesn't go back so quickly. No, the effects are lasting once you reach a state. So, we do recommend that the people come back to us for like another boost session. But, yeah, the effects are pretty good. I'm pretty lasting. So, who is nearer feedback for? We say it's for everyone. So, I've talked to you about the patients just now, but we also see lots of businessmen, you know, top managers who are stressed all the time and we try and sort of do vaccination trainings with them or concentration trainings, focus trainings to increase productivity. So, that's more preventative training. However, we are working towards taking this into health management and we have some big projects going on there. It's nothing new to the world of sports to be around for decades and particularly in the field of golf, it's a very... a very useful tool because when they're putting, they have to be focused in the moment and every movement has to be, you know, carried out carefully. And there are some interesting studies there as well if you're interested. We see a lot of students who come to us who have difficulty taking exams because they get nervous and even though they've learned everything, they fail. So, we'll combine the nearer feedback with example questions perhaps from the exam and just go through it with them. And we also see artists. So, we have a project going on with classical musicians in Augsburg. It's surprising how competitive it is. If you've gone through the whole classical training in music, classical music training, you end up competing against 500 other people for one job in an orchestra and you have to audition so you're playing, you know, behind a curtain so you don't even see your face whilst you're playing. So, they need to be able to perform in the moment and we actually receive feedback from one of the people we're doing a study with saying that he got a job and he says it's only due to nearer feedback that he was able to perform. And that might be a slightly extreme statement. I mean, I wouldn't say we can, as I said earlier, we can't cure everything but he associated it with nearer feedback, which is a very positive thing so it's definitely a helping tool. So, that's pretty much about nearer feedback itself, like the basis of nearer feedback, I guess. Now, where do we see the future of nearer feedback? And these are things we're doing at the moment in our practice. We're sort of trying to develop new technology and new methods and we're working with virtual reality so we're creating whole environments that will react to your brain activity which would make the whole experience more intensive and it also takes away the distraction because you're sitting in the room, you know, in your chair, doing your feedback on a screen, you always have a therapist sitting next to you looking at you, watching you. So, this is probably going to, we hope, lead to stronger effects and a more fun experience. Now, you also have the mobile training systems that we hand out as an addition to the therapy. It doesn't replace therapy but people are using it at home, for example, maybe to help and sleep. So now, before going to bed, they might do a new feedback training to sort of calm themselves down and then fall asleep easier. Yeah, so that's pretty much nearer feedback in 50 minutes. As said before, there's a break now. You're all welcome to come and have a go and test it out for yourself. Yeah, thanks for coming out and listening this evening. Thank you. Thank you very much, Stephen. And as always, we have time for some questions. So, robotics, the goal is to read mind or one of the things is to read mind in such a way that it can be, for example, applied for controlling machine or something. It doesn't have anything in common. I mean, there are some things in common but we're not trying to read minds. We're just giving feedback about the brain's activity and we're using computers to do that. Yeah, so it's not quite the same thing. It's not quite the same. So one question. Somebody who's bipolar or other disorder, how can this help? Right, I didn't mention this. So we see a whole range of disorders and I showed you the brain map just now, the colorful pictures of the brain of the head and with different disorders, so like, for example, the depression or with bipolar or a whole range of disorders, you come up with the same patterns over and over again. So based on these pictures, we create a training protocol to decide which frequencies are we going to train or which location on the brain and then we just work towards it. But it's not sort of like a psychotherapy we're not talking through their problems. It's more of a training. It's more of a training rather than therapy to keep it positive. Yeah, in general, this is more than an addition to treatment they already have. It just sort of helps that. So it doesn't replace other treatments for serious disorders. It's an addition for that. Okay, from this side? Yes, you are on the back. What do you mean by fixed, external? Yeah, that's basically what we're doing. So we're rewarding the frequencies or the amplitude of the frequencies that we want to see in a healthy functioning brain. No, we don't generate frequency. No, we're just measuring. We're measuring the frequency in the brain and we're feeding that back. That's all we're doing. It's much more simple. It's a long theory, but we don't do that. I have done it in the past, but that's not what we do. Yes, please? Yes, and then after that. Yeah, well first of all, when people come with depression, they're in treatment with a psychiatrist. This isn't replacing other forms of therapy. It's an addition to what is already being done. The thing is, the typical person with depression is someone who has gone through all the medication and we know it's trial and error process until you find the one that works for you and they say it's just not working and they want to try something different. Then they come to us. We have a doctor in the practice as well who I work for. We do also contact the people who are already treating them. We are very careful with this and we are very responsible. Okay, I have to cut the discussions because I promised him to get the questions, but Steven is also available during the break. The feedback can be a game. It can be a film. We always combine it with music or sound of some kind, so they've got the visual and the auditory. In theory, it can be anything you can feel. It could be a massaging chair that vibrates in theory. The feedback that reacts to the threshold that you're going over, right over low. That's pretty much how it works. Yeah. No. No. Okay, thank you everyone. Thank you, Steven. One more time.