 No, if you've done a conduction, I just want to make sure that you don't have to do that. Okay, we need 10 hours. Okay, 10 hours. I'm going to pass around these devices. You're not going to use them for 45 minutes, so I'm not giving any instructions. Okay, I've got to watch my liability stuff. Okay, you found a knife on a pillow to pick them up. But then you'll just give you a little bit of a sense of what the experience is. For the bottom, there's four dials on the bottom, and those are volume. Left and right are your volume, and then the right dial on the top is pitch. How do you feel, how do your body feel, what your physiology is like, what your experience is like, when you're experiencing or remembering something that you do not want to continue to carry with you? Okay, so I told the story about my brother, he's annoying. Okay, do something easy, please. Don't do like fire burning buildings. Okay, do something very easy. I don't want to have somebody start screaming in the middle of the end of the presentation. So you're going to set that, you're going to try to find the pitch that matches, that enhances that feeling a little bit. Okay, and then you're going to find the structure. And you play around with them. It's just like you're fine-tuning on old, white camera videos, and you're going to have to be a squelch. That's kind of what you're doing, you're squelching. In fact, turning anything. Some people don't know what I'm talking about. You just dial it on the radio, too. Oh, don't, we're not going to report that. No, this is just for our way for people to come in. Thank you. So, I'll start here. If you don't want to do it, just pass it on, okay? The next one is the David. This is audio-visual and training. I'm going to have it set on a relaxation first of all. It has a lot of pre-cold in it. So, you can have it set on just standard, alpha, amen. For people that don't know what that means, alpha brain waves are your idling brain waves. In order to be alert, you should have a nice idling range. And so we're just looking to enhance that. So, you can... There's three buttons. The one is select while there's four. There's a switch on and off. Don't touch that. Don't touch the select. And then you can do... There's an INT for intensity and BOL for volume. But I'll say that again. I just want to show you that real quick. You want to do this with your eyes closed. They do have ones that you can do with eyes open. Can you see? It's a little light. Okay. The way this works, it's a two-way dial, but you have to go all the way. You can go more intense, but if it's too intense and you want to make it lower, then hit it again and you'll go less intense. So, for some of the risks, I go all the way to the end of the line to come back to the beginning of the line. Okay? And the same thing with volume. Okay? So, it looks like we're on time to begin this part. And, well, one of the discussions that we were having when they asked us what we can talk about it and what we could offer to this meeting, it was a big interest about trauma. And we know that trauma, emotional trauma, and no injury trauma has been a hot topic lately, right? We are switching and paying more attention to emotional trauma, and now we are more aware of it, and as we are aware of it, we need to understand it better and learn more what we can help these individuals. So, as I mentioned in my introduction, I've been working lately with Bessel van der Kog and I have a strong background in EEG, QEG, neurophysiology, epilepsy, was my main condition that I studied. And thanks to Angelica and things that happened in life, I was connected to Bessel and Bessel interviewed me and said, well, you have very strong background in neurophysiology, in neurofeedback. I said, yes. What about trauma? I know nothing about trauma. And he was, okay, don't worry. We have a team of 30 people that know trauma. We have nobody that knows EEG and neurophysiology, so I think we can make a good team here. So he invited me to join at that moment the trauma center, me knowing nothing about trauma, right? But what can happen? I came from neurological rehab. I was treating these very severe brain injuries, extremely severe. These cases that nobody wants to touch, they are very complicated cases, so I was treating these cases. So trauma, what can happen? I mean, I've been treating very hard cases. So I was like, okay, let's do this, right? And, oh, my gosh. But I found it was extremely hard, complicated, dysregulated condition, and I'm still learning and barely new in the area of trauma, just two years. So I have been very lucky to work with Inat. Inat Rogel is my colleague. We were running together at the neurofeedback clinic in trauma center, and a few months ago, we decided to open the private practice in Boston neurodynamics. And Inat is a clinician that has a lot of experience with trauma, so we combine very good, and she's teaching me a lot, teaching her a lot. But really today, just the boys of this lecture, she's the main author of this lecture, and I'm very lucky to present the data of two main studies today about neurofeedback at trauma. The first study that I'm going to show the results is a study that is already published in PTSD and neurofeedback. The principal investigator is Bessel. Van Der Kolk and you found this data already published. It was a very good study that really break through, break through the information of how we can use neurofeedback in trauma. Bessel has been a real visionary helping to understand, to educate professionals to use and implement neurofeedback for trauma. So it has been very helpful to in that direction. And the second study that I'm going to show the results is still unpublished. Okay, so you're probably to be not the first audience, probably the third audience that see this data. And hopefully very soon the authors can get a published, very nice published paper. So it will be there. Okay, so let's learn more about trauma, right? So what we knew or know about trauma is that we have had this criteria for PTSD, right? We know this is the main criteria for PTSD diagnosis and it's somebody that has been experienced some injury or sexual violence in other many ways, directly with a witness or learning that other family members were exposed to trauma or experienced a repeated extreme exposure to other traumatic events. So it could be violence, natural disasters, divorce, being separated from parents, blah, blah, blah. But what is different between developmental trauma and PTSD? And this is there a big awareness that we want to raise. There is a huge difference. Between being exposed, your brain was developed in a normal way and all the circuits were connected in a normal way during childhood and then you were exposed to a emotional situation that provoked all the symptoms that we're going to discuss, right? Different in developmental trauma that we need to consider as a separate diagnosis and in many ways it's different, okay? So this is what I was talking about, that PTSD there is a line, right, before and after and what happened. In developmental trauma what happened is a chronic exposure to the trauma, violence, abuse, neglected in early age, right? And we know right now is a huge public health challenge of the consequences of being exposed to trauma in childhood. It can affect the well-being, mental, neuronal development and the child abuse we need to consider in many different levels, right? It could be physical abuse, sexual abuse, emotional, neglect, interpersonal violence, community violence, intimate partner violence, bullying. Now we know very strong about bullying, right? We identify how important and how much can be the effects of bullying in developmental trauma. And we were talking about attachment. I was right now in lunch giving half of this lecture. So I was very happy that the audience was so aware about it and they mentioned about attachment, right? What happened during childhood? The brain of the baby is learning from the surrounding environment and the connection with adults and other family members and people around them is so important to develop healthy circuits. So to be engaged in communication with adults is really huge for this brain that is learning and developing, okay? So it's not only just looking to them, it's really responding to their emotions and in an emotional way. And we're learning more and more about these experiments and these clinical trials about the still face. Are you familiar with this experiment with the still face? Usually I'm not with this video and it's very nice representation of how the children can immediately, and this video is so remarkable how the kid, the toddler is starting having some emotional response to an adult that is in front of them but they are not responding emotionally, right? And this is what happened in developmental trauma. And the brain is developing all these processes, right? How to have feelings with others. How you are knowing what you are doing on yourself. It's a lot of learning how they are interacting. So when we have a mental health parent with a mental health issue, right? That they cannot have proper attachment and appropriate emotional connection. This is already affecting how the brain of the baby or the kid is developing. So what I was most impressed when I started learning about trauma is how little we are aware or we really ask about trauma to our patients, right? We think that trauma has to be something very strong like a huge event that really happened in their lives. And this study with thousands of children they were just counting how many trauma how many experienced trauma they have through their lives, right? And they found that 75% of this population that they studied were exposed to multiple experience of trauma 25% at least one, okay? So, of course, now that we are learning all that in our clinical intake we need to have a huge part that we ask about trauma exposure, right? And at different levels. Because we know it can have effect in all these levels. Academic difficulties, behavioral difficulties attachment problem, suicidal substance abuse is very, very big. The adverse childhood experience study I think many of you are aware of this study is like a must-show in a lecture like this. It was a very large study where they follow 17,000 adults and they measure how many traumas they experienced during childhood and what was the effect of that, okay? As an adult, what was your clinical effect of being exposed to different emotional trauma during childhood? And these are the types of childhood events that were measured, emotional, physical, sexual, neglect and all these different household challenges, right? And if you see here I mean they are very common, right? In many societies at any economical level, I could say. So from this study these were the percentages that they found exposed to the trauma events or trauma exposures and overall 52% were in these categories. And they have very nice graphs of this study where you can see exactly what is the level of how many trauma exposures they were exposed. But this is I think the most representative what is the effect, what is the impact of this exposure to trauma during life, right? So of course it can disrupt neurodevelopment we can evaluate these children how they, all the developmental skills are in different rates social, emotional and cognitive impairments they are having higher health risks behaviors, diseases, disabilities, social problems and nearly that. So if you read the Selvander Kohl's book he's talking about the body, right? And how the body is paying the price of being exposed to emotional trauma during childhood and this is where we then understand why we can have seen effects in health health related issues and so how is this related? Why they get sicker? Why they have all these symptoms in diseases? Why they are more prone to have substance abuse, etc. So now we understand better. So the population that is in high risk for developmental trauma are the ones that are young with low education, single childhood large number of dependent children low income, history of abuse of mental illness poor parenting skills if they transit for other caretakers communities with violence and poverty chronic medical problems and special needs. And this sounds like quite straightforward, right Jess? This sounds like hard to raise a kid in this situation but there are many other situations that we don't even imagine that could be a problem in this family in this community. So we really need to ask for it ask for that in very detail. And oh yeah we're going to talk more about adoption during this lecture but yeah we know that whatever happened before this kid is adopted right the older they get adopted of course is going to be harder but sometimes we see kids, babies that are adopted in months old and the months previous before being adopted they already were exposed to too severe trauma and this will have an impact for the rest of their lives and these parents are so enthusiastic about adopting the children and they will full the kid of love they will give them everything they will need they will have the happiest life ever and they will be the most successful parents and have the parents to have a kid and what we know now it doesn't matter how much love you can give this kid or how much resources or how much support right the damage and the problem was these stages that he didn't have the care and it will be very hard to regulate and go back to normal so it has a huge impact on difficulties and all depends on the age and all depends on what level of stress it was exposed now we know the neurophysiology components of developmental trauma we know about hormonal abnormalities the cortisol is increased in malted children and decreased in adults with PTSD so there is a difference we are understanding that the stress is different in children than in adults right and we know that when the children is separated from the mother the mother just went to the bathroom but the kid doesn't know that the kid doesn't know that the mother is only in the bathroom for the kid is already a huge huge loss he doesn't know that the mother is coming back and the baby is already very stressed it's my mother, my only attachment to be alive is going to be back and save me so we need to understand all the stress that is processing this child even for short periods of time and this can affect all the physiology and regulation increasing acute response and decrease develops over time due to developmental trauma effects of trauma and here I want to make a comment of my clinical experience treating trauma is that these children that grew up in such an alert and overactivity stages so they needed to survival mode was already all the time on they needed to be ready to survive to run, to save their lives all their childhood so adrenaline, all the hormones or the physiology is so activated all the time, non-stop okay and then there are adults and they are trying to cope with life and when they have this very adrenaline experience they feel nothing this is a normal state so I have patients that I say oh I just went skydiving and I love it and it's amazing and I would like well but I mean it's a lot of adrenaline it's a lot of what do you feel nothing nothing I can skydive and it's my normal mode okay so for me this was a very good to understand what these people live what is the normal state for them it's like they are constantly skydiving right and this is what the body is responding all the time so of course there is an adrenaline response and in fact all the hormones are so active and of course there is a moment that they reach a plateau and then they go down and there is also effect during puberty, huge effect during puberty when we have adopted children and they are well we are trying to help these parents about how to introduce more interventions and more therapy and it's before reaching the teenagers we said you need to do something right now because when they get to teenager brain it's another level of difficulty right now we are going to face many other obstacles that happen in the neurobiology of the teenager brain so the impact of developmental trauma during childhood affects all the neural systems of the brain and compromise the functional capacity mediated by these systems so what we are measuring what we are learning about the physiology and the brain of these cases well we are understanding that the brain is working differently when we are recording a QEG of an adult a teenager adult that survived childhood trauma is going to be definitely different of an adult that didn't live that experience and this is what I was explaining before the brain of a children supposed to be developing in a secure calm protected environment so the brain needs to be developing social skills and how they need to develop I need to develop in social skills I need to develop in other type of learning moral learning etc all the things that the child needs to develop these kids are just protecting themselves the brain is just forget about learning who wants to learn let's be alive this is not our priority we need to keep alive this person and this brain this is what is wiring in this brain so it's definitely different we don't have yet the neuro markers that we are looking for developmental trauma we are having very soon more research studies that we can find in a QEG this is a brain that suffers developmental trauma and we are very close to that I think we is very evident way evident that I could say with other conditions it's very localized limbic system regions there are very specific regions of the brain that we know they are affected during neuro development we also have another component the ven related potentials the ven related potentials is another neurophysiological measure it helps to understand how this brain is processing sensory information so in QEG we are just measuring electrical activity constant electrical activity the brain is producing this activity by itself the ven related potential is a response to a stimuli so it could be a visual stimulus sensory motor cognitive stimulus and then we are going to measure how this brain is responding so it will help us to understand way better why they are processing sensory information so different and this is very common in trauma and when we are measuring ERPs we understand and we have the objective measure that this is true this person is feeling different is hearing different they see the things different and of course cognitively they function different the sensory processing is way different from a normal developed brain so now with the HBI and the Brain Arc project we want to get better understanding of that so we will be able to target more precise interventions for this population so here what we can see is an ERP of a normal brain developed so they have a stimuli and this is a normal P100, P200, P300 response and this is a PTSD brain right so they respond all over the place not in the direction they should know, they should go and there is a reason why for each of them ok now I'm going to show you the results of the adult study this was it was published I think almost 2 years ago but of course I'm going to show you 10 slides of probably a 6 years project and it was done in trauma center and it was the first study that was done in the area of feedback and trauma this was in adults so the goal it was to help them to with developmental trauma who are stuck, do you remember I was mentioning stuck and we will mention in more detail in the next lecture but really this is what happened with trauma they try many different therapies as an adult they come to look for us after 10 different therapies and they are in the same place they are not moving forward they are still remaining a lot of issues so we want them to help them to be on stock and keep looking forward for improving so in this study this was a random study they have 52 individuals diagnosed with PTSD PTSD because the diagnosis that is accepted so far they were randomly assigned to a group of neurofeedback or a waiting list they have 2 times evaluation a baseline after 6 weeks post treatment and after a month of follow up the inclusion criteria they needed to be 18 of up they needed to fill the criteria for PTSD in the DSM or by the CAHPS this was all the exclusion criteria I think something important well I think this is a very standard that were people that could not participate in the study and this was and still one of our biggest research questions what type of protocol we can do for PTSD what type of feedback this is research and for research the ideal is to have a standard protocol for everybody ok so even if we have QEGs and I will talk about the QEG we couldn't do individualized protocol now there is we are trying to figure out this could be an option to have individualized protocol but standard protocol for all the subjects so this is why they did it before it is well known that the limbic system is involved in trauma the temporal-perietal conjunction is one of the spots where we have seen more abnormalities in the QEGs of adults with developmental trauma and there is bibliography neurophysiological background that guide us more to do it on the right than on the left that lately we have found something different but well this is what they did in this study these were the frequencies that were trained two bands inhibition and one band rewarding they did twice a week for 12 weeks total of 24 sessions they did all these questionnaires and inventory this was really a big effort of course all related with PTSD symptoms and these other scales ok so there are results of the PTSD criteria comparing with the winning list group this is the evaluations that were done baseline post and follow up so we can see that there is a huge reduction a statistical significant reduction of the criteria of PTSD in the treatment group and they really stay very stable after the follow up this is a winning list we are not surprised that even that they didn't get the intervention we see some effect they didn't even have sham this was just a winning list just people that was measured there is a lot of of information we can provide why this happened expectation and some kind of placebo etc in the different other scales that were measured we see very good improvements in all these scales affected regulation scales deficits affecting stability abandoning concerns all these were statistically improved in all the clinical evaluation there was a profound effect on the executive functioning and this is a big question that we have why were having effect on the frontal lobes it were training of the back of the brain right and all of you probably experienced that if you have you are training one part of the brain but we are seeing improvement in functions that are located in another part of the brain and yeah it makes sense if we help this brain to calm down the limbic system and teach this brain you know you don't have to be in survival mode you are finally in a protected environment and you can rest the frontal lobe will be okay now I can function now I can make better decisions and now I can plan organize better because I don't have to be in the active survival way all the time okay and we can show that in QEG maps we can see just regulating the limbic system posterior part of the brain we see boom improvement in the frontal lobe and of course the brain is a net all this connectivity and structures that connect with each other but this is basically the main reason so we see improvements in planning decision making a correction mental flexibility this is huge in trauma huge they are so stuck and so rigid in how they think and so little limit on getting upset or sad or just having more flexibilities very very beneficial in their lives dealing with danger and impulsivity self-regulation so this is the author of the paper here it is some more results inhibition shift this is all the brief the brief subscale the executive functioning all positive results it was really a positive study all very very dramatic and very good results with 24 sessions of neurofeedback only one participant had side effects flashbacks okay this was good they were lucky now they finish that study and then they say okay it's very nice that we can help adults of course we want to help everybody but if we can help children we can really direct them in a different way in their lives right actually the best radical goal is to really help the children to stop helping them dragging all these difficulties to their lives and they can have more productive adulthood and so they say okay let's do children that was the next research question can we do the same with children this is a big question that we have if the brain is still in development can we reverse some of the neurodevelopmental issues that happen in this brain okay we don't know yet we are trying to understand so they did again a randomized study and again this is another four or five years effort and yeah so they have very successful results with the adult study now we want to see in what children is any difference so they have a population of 6 to 13 years old children that suffer at least two type of trauma that they have significant symptoms in these scales in the CVCL and the post-traumatic stress symptoms stable in all conditions medications therapy etc commitment with the study that this was very difficult to find the subjects that they were committed they have some exclusion criteria it's just basic if they have other medical conditions other type of medications so they have life-threatening situations so they live very far so these were the demographics of the subjects 37 subjects and everything is pretty stable in this study just here that most of the population they were adopted they were only like one or two kids that live it with their biological parents so yeah we find this very common in adopted population they will have probably the first I don't know if there are clinical trials that show different responses in gender differences they are going part of the results of this study is there was a gender difference response to neurofeedback so stay tuned for that results so this was a trauma profile for the subjects in average of 14 participants experienced one type of trauma average of seven different types of trauma per participant so yeah more than two so I don't think you can read all of that but this is at least of all mostly oh my god not even me I can read so separation neglect impercargiver emotional abuse physical maltreatment domestic violence traumatic loss et cetera and this is how they randomize the groups how they did the screens they were all evaluated they divided in a waiting list and then in an active group the waiting list after the they completed the evaluations they were offered to do the active treatment but there was after they completed the evaluation so I think this was something very nice considered from this research okay that's it here we mentioned that they have also the three measurements the beginning baseline post treatment and follow up they replicated the same protocol they did the same protocol before the difference was that they were rewarding the band three from one heard below the posterior dominant rhythm in age 6 to 13 the brain still in development so the posterior dominant rhythm still changes right so this is the most accurate way to find where is the PDR for the posterior dominant rhythm for the subject they did a slow inhibition band and a high inhibition band and the the length of the session the aim was to do the training for 30 minutes okay I will talk about what happened because not everybody could achieve the 30 minutes but that was the goal and they were twice a week for 24 sessions oh actually here is the note in reality sessions were between 6 to 12 minutes and this was probably the most shocking thing that I learned with trauma how short the sessions needed to be when you are regulating the brain with trauma they are so sensitive and respond so fast or for good or for bad we are going to talk about it so you need to be very careful with the time of the training because the brain reacts very very fast okay so these are the different assessments that were measured they have a lot of different very specific questionnaires so here is the results after 24 sessions they were statistical significantly improves in the symptoms of children with developmental trauma in all these scales behavioral cognition emotion trauma related dissociation lexitemia is their ability to express their feelings so this is trauma they are so separated they don't understand what is going on when you ask them what do you feel playing they don't know so to be able to express how they feel is actually one of the scales that show more significant more statistical significant I was telling them they need to publish just the results of this scale because what's remarkable I'm going just to screen and show you all these graphs how this this is the baseline this is post and this is after the follow up okay and this is the waiting group and this is the active group and what happened there was a very nice improvement during the treatment but once I stopped the training they have a little bit of regression a little bit some scales could be statistical significant the regression some of them not but we are going to see this shape in all these scales going down and then up again a little bit so we are learning a lot about this and the first take away is 24 sessions was not enough right? now the only the other thing that we keep looking is that we are seeing it less than in adult study where we are seeing also some effect in the waiting in the waiting list but this got even worse right or they were flat as well so this is the brief this is executive functioning and behavioral regulation a little bit of regression metacognition behavioral checklist internalizing alexitemia this was very very nice when you see the different measures of alexitemia was very nice trauma symptoms anxiety depression arousal dissociation and affective disorders this was a little bit more severe afterwards right ok so it was a really nice study we learned a lot from that but yes we know 24 sessions is not enough and we have so many questions for the next research because so many questions that we went to answer and we will begin our next clinical trial in January so we need to put our heads together what are going to be our research questions now QEG what happened with QEG right and this is where we get in a big fight the QEG oriental clinicians with no QEG oriental clinicians when I arrived there they were already finalizing all these results and they say well look we have all this QEG data can you help us to do the analysis we are going to find so good results it's going to be so good and we are doing all these analysis and not finding much difference and not finding much difference as a group level ok yes it's a short number of subject this is probably a big limitation and but we still convince that we are going to be able to publish in some degree because in an individual level we saw so many changes most of the cases they show differences but it's not like in the same frequency band and it's not in the same location and it's not in the same analysis so these are the variables that are getting in our way to have a good statistical results but we see that this is just one of the cases this is pre neurofeedback this is post and we just see the excess of data and now we see a significant regulation of excess of data and exactly in the regions that was trained right before before this is one way other type of improvements that we see probably what I show you was absolute power this is coherence values and in this case we didn't see any changes in absolute powers but we see improvements in coherence when there was an excess of coherence in TETA band and this is post-intervention right so this is where we were finding and we're trying to figure it out what we can show in this data and this is why we learn also that we need more neurophysiological measures and our next study we will add ERPs component so we can have more to explore and expand what we learn in this in these cases I really like all the quality and personal reports from the subjects and their parents right and this is why the experience that at the end just we need the research and this is a very important component but at the end we want to have a better human being whoever we're helping and we want to do better in life and looks like this study achieved that mother was so pleasant to be with this kid didn't have meltdowns this is great she turned to be a person right and all this from my son and me so this is very common he still swears at me but we work on strategies to stop it it takes him short of time to recover and these episodes are not as severe he was crying and sad he was sad so this is very common that probably the symptoms or the responses won't totally disappear but they will have better resources to self-regulate and understand and tell them there's no way then children's reports my sleep is better it makes sense what the teacher was saying before it was blurry I feel relaxed and calm I like to calm, it helps me I feel better, I don't think I could go to the camp without neurofeedback I don't feel this child report after a year post neurofeedback I don't feel calm, I feel more nervous I want to continue neurofeedback so something that was also very nice in this study all the subjects love to come to neurofeedback all of them, they are happy and enthusiastic and they and I think different from other conditions between other conditions I think I think they are more aware or they can see more their challenges in life they can see that they are getting better they are definitely enthusiastic to come and see that it's helping them but unfortunately this is something that we are also learning more and more that we have high risk is a population of very high risk to have a birth reaction they are so sensitive, they brain response so fast they are so reactive to the change that is happening in the neurofeedback that they can have a birth reaction heavy, tiredness sleep disturbances, affecting their attention impulsivity, behavior adverse moods increasing the anxiety yeah and they found that sessions longer that 6 to 12 minutes it could have more higher side effects the good news is that we can address them and resolve them this is why we need very good feedback from every client but this in particular we need to have very clear feedback so we can help them to reverse the side effects and unfortunately these are clients that are not very good reporters they won't tell you in detail they won't they don't know what happened they don't feel it, they don't understand it it's very difficult to take all the information from them so this is when we have to have more resources or have to track the progress and we have to be very specific what we are measuring what they have to write what they have to let us know so oh, this is a poor reporting also we learned that it's essential to combine neurofeedback with other therapy neurofeedback with any biofeedback technique we understand that we are working at the physiological level right, we are helping to solve regulate and modify physiology to reduce the symptoms but whatever is happening this we are going to be able to change it but we are not going to be able to change the past other parents or the school or the teacher is still there or life or stressors they are going to continue being there so this is where we need the therapies back up because this will continue being there neurofeedback, biofeedback is helping to regulate and more things are going to come up trauma is very, very important to have side by side therapy and at the beginning they are very resistant to oh, I've been done this for years I don't want to go back to therapy this is why I'm looking for neurofeedback because I don't have to talk I don't have to go again through all my trauma, I don't want to go through my trauma again, I want just to do that right and we are not just telling the audience you have to go to talk therapy and talk about the trauma, no we are trying to help them to identify other sources of trauma therapy without being that talk therapy sensory, motor EMPR other type of therapy that can be helpful for them to get all the benefits of neurofeedback but we need definitely the back up of the therapy in the study what happened is that sensitive information was disclosed during the sessions suicidal thoughts gender issues and we were just doing a neurofeedback session we cannot address all that so this is why and probably these ideas were not at the surface level before starting neurofeedback so neurofeedback helped them to develop and get these emotions and situations to heal in a more in another level to be processed increase emotions and yeah, it can be affected to therapy and somebody else here told me yeah, when you can actually have severe side effects if you don't combine other therapy with neurofeedback and also we learned 21st sessions is not enough right and this is from many questions that we have about neurofeedback this is probably one of the biggest one that we don't know how many sessions do we need right, this is the first question that your client will ask you how many sessions I will need this is hard to answer we will address it a little bit after in the next lecture so this is how you need to keep track of all the neurofeedback changes having checklist or logs that would be very helpful and of course outside the protocol you need to adjust the protocol as they are reporting to you I supervise clinics internationally and with less trauma more like more neurological conditions and the patients that I switch and change and modify protocols more often is trauma oriented patients because they react so fast and we need to reduce that no, change the side here didn't respond well, now let's do it again so it's a lot of really understanding and knowing more about this brain to see what we can do and see how they will respond the challenges of the study most participants were treatment resistant so they sent all the patients that didn't respond to other therapies addressing increasing interest emotions like depression at the beginning the challenges they didn't want to come raising the electrodes in children that were too sensitive to touch this is a highly sensitive population as well and engaging children also that was probably my first time that I had the most difficult experience recording at QAEG and I have experience with autism okay so I was like well I've been doing an autism I've been doing a trauma challenge they are so sensitive like this is painful and it's real pain nothing that they are making it up it's real pain for them so it's really a challenge with the sensory issues the limitations of the study here the demographic most of the participants were adopted who live in the middle upper class family hopefully we can get to the kids that are in more need and this was the pilot study small number of participants, small number of sessions large variability different types of trauma, ages multiple inclusion criteria and one protocol we only use one protocol independently of the QAEG challenges that we still face with neurofeedback we wish we can understand more and more the mechanism at the molecular level and the network level need more research basic research students, here is your homework length of sessions, frequency of sessions we don't know it's better to train them twice a week three, six once a month for sure we don't know oh this is what I was telling about the commercial companies and black boxes all these devices that they don't tell us what they do but just buy it and all technology that are not friendly interfaces and problems with amplifiers and wires and games we need, this is one of our goals for the research protocol we are going to look for neuro markers in developmental trauma for you to understand that childhood developmental trauma is different from adult PTSD and all these are the different emotional factors that we have to consider every culture is different there are cultures that will be more open to talk about it and tell you there are many other cultures or education levels they won't tell you at all I found lately in Mexico with my patients in Mexico that you really need to be a detective to find for trauma they will never tell you never, everything is so nice violence are the best people in the world kids are doing great they don't regulate emotionally we don't know why it can be genetics but what is going on so you really need to scratch, scratch, scratch and you find it out eventually you find it out and this kid has been abused doesn't have to be a severe abuse emotional psychological abuse in a low level will have a huge impact so I'm talking to Bessel and to all these great researchers and everybody how we understand better trauma we understand better what is going on we are finding interventions to help them very fast we need to move to educate the population to prevent trauma because in Mexico or probably many other places there's no better way to educate kids we need to hit them and this is why we have the belt and this is normal we are raised like that and look we are here we are fine but yes what about your anxiety and your health issues so we really need to educate better parents and community that how we are raising the kids is having a huge impact and how interacting and attachment and spending time with them and taking care of their emotions and be there it has a huge impact and how these brains are developing and people don't know better so I think this is our next job to help to educate the people well very thankful to be part of this group as I told you I'm just the boys here and happy to they were so excited just please shovel the slides spread the word to try to get with more people interested in these projects we are going to start a new trial in the new trauma center clinical trial and we are just looking for contacts people that wants to collaborate if we have other spots there are people here that know about what is happening in the border with separation of the kids we want to go there they said that is very hard but if you know any need to help children that has been exposed to trauma and we have the options to help please let us know we are really really looking forward to help this population okay this is Boston anytime you want to come and visit thank you I think we have a lot of time yeah we're going to take a little 10 minute break when we come back we're going to do some stretching exercises do you think we have time for questions after the break I would like to have more interactive absolutely they can get the mic and ask questions we're going to do some awards real quick and do some stretching exercises and you're going to enjoy it and then you're going to wake up and ask questions in the next presentation so 10 minutes hello hello hello hello hello hello hello hello hello hello hello hello hello hello hello You know, I have a flash drive that has no presentation, and so we want to stand and