 And I think it's a pretty good symbiosis. It's certainly good for our program, and I have many of my students or former students here. In fact, I think we probably comprise about half of the attendance, but it's also a nice venue to have a conference. So thank you for coming and welcome. Alan, did you want to come up? Where's Alan? Oh, there he is. There's a couple of people that we were asked to recognize by BCIA for just their outstanding work over this past year, their dedication and passion, and Shannon Kraski. Krakki, sorry. Thank you. Let's give her a big round of applause. And we had the excitement this year. St. Mary's also has a program in town, along with Mark Jones. We're doing our own program, but united as you can see, and we're excited to have our students here as well. But this year at ISNR, we had the pleasure of one of our students, our first student getting our first award. The many more come with Dan Reed, got what was known as the Jeannie Davis Scholarship Award. So just bring him up. And that is the award we're recognizing both of these students for. And Shannon's been in the program, very helpful and a quick learner and outstanding in a number of ways. So we're glad you're able to get through the award and come up here, get some pictures made. And unfortunately, we don't actually have the award. They are in the mail, right? So, all right, let's... All right, we're ready for our last presentation. Let's keep our energy levels up and take in this good information. Congratulations to the students. It's so good. I wish I... When I applied for my PhD, it was so hard to get an advisor that understood what I tried to do. So, it's so nice that you have all the support and great mentors. Okay, so our next lecture, one of the interests of the society was... You know what, we got switched off and somebody... So I think we're still on... Somebody who messed with the music. I wondered who it was. There we go. Okay. So, one of the interests of the society is what else we can share, what else we can help all the attendees and I'm very lucky to have been working with Angelica. She's... How many years, clinician? Experienced clinician? I'm sorry. But, I mean, I... When I was living in Philadelphia, I was very fortunate to work with her in her private practice and it's amazing what they do, how they run this... I mean, medium-sized practice, neurofeedback practice, and I learned so much from her, their logistics, their process with the client, their understanding, education, all the steps along that are very important to have a successful case and help the clients as much as possible. So I learned from her and with all this learning, I still did and I was able to then open more clinics around the world and help more people. So I think we both have a fairly good amount of clinical experience and Angelica running so many times and I don't have that long-term experience, but I have experience in setting up clinics to training clinicians, what are the procedures, helping to guide all the process, so we hope you find it helpful. So we're going to cover about this. How do you need to prepare the client before biofeedback and neurofeedback training? When you talk to a new person that's stepping to your door or somebody calls to the phone, the information that you provide there, at that moment, you can't direct it, they are coming to your office or they are not. How do you explain this intervention to them? So it's so, so special that moment in the first contact you explain the procedure to the client. Now, it's not easy to attract them immediately in two minutes, in one minute that you have them in the phone. You have to be very precise what you want to say because it's a complex procedure. You cannot talk, okay, it's neurophysiology and you will ask them there, but also they are calling because they want to understand what it is. It's not something that everybody else has done in the past and they can't just go straight and I know what it is. We are not selling shoes, right? Everybody knows what is a shoe, so they know what they are looking for. So it's very specific how you need to approach the client from the beginning and when they are in their office how you are going to instruct them. We are going to talk about very important about the relationship. This is a key to have a successful intervention as any other psychological intervention or medical intervention about the procedures and the guidelines that we will cover. Thank you. So I actually want to go back to that because Diana put out some things that are very important. From how you answer the phone I would feel like the day somebody calls your office that's a bad day for them. They finally decided they are going to take care of something that they have not been able to do take care of successfully before or that they have not even taken care of and so we really need to be extremely welcoming you know more so than hello, they are psychological we need to be able to convey to them I am happy you called and I am happy for you that you called and we want to make them feel enthusiastic about what is happening that they made the right choice. So I spend a lot of time personally on phone calls. Now I am not in favor of free first sessions. What we do is very hard it is very complex and I can't go and get a pair of shoes for free so I don't think you should be able to get therapy or neurofeedback for free but should you be able to tell if this is the right place for you to start? Yes, I think that's fair enough. So I will ask people why did you call? How did you get referred here? How did you find us? Oh I looked you up on the internet what did you Google? How come you picked us? Why us? You live in Delaware why did you pick us? What was it about our website that attracted you? The website is very important if you don't have a website get one fast it's very important So from there oh well if people may call and say I want therapy I will ask them okay do you mean talking therapy because we also do biofeedback and but do you know what biofeedback is? No, no my insurance company told me you do therapy well yeah we do but we do biofeedback and biofeedback is a process of understanding how things are happening for you and us helping you to learn how to improve them yourself so that you have a skill that you can work with people are like oh I'm interested in that maybe I'd like that and if you're like I don't know I send them to the website educate yourself learn about this and then make a better decision don't just how many times have you had somebody that has gone to therapy oh yeah I went to therapy for five years how'd that go for you? not so good and you've seen it for five years because they don't know what else to do the people don't know what to do so it's our job to help them yeah so if you have questions later alright so is it a suitable intervention? that's tricky to decide over the phone so we gotta get them in and I'm saying to people why don't you just come in don't just talk about it you don't have to make a decision over the phone if you want to stay with us what I want to do is help you understand and I want to get you to the place that's best for you that's what my job is with that people come in and we want to do an intake I'm out an hour and a half for the initial session I don't like to be rushed there's always something I forget always you talked about rainbows earlier oh wait a minute before you go I didn't ask this how many times do I just forget because it doesn't seem relevant do you have headache? oh yes I have my brain right now you didn't mention that well that's not what I came in for so as much time as is needed is really what we take and if I can get it done in 50 minutes if I'm working with somebody who has an exhausted child the child is out of control I don't think that kids stay there for an hour and a half if I don't need to if I can get enough information to say let's just begin with a little bit okay there was a person in our town who was new to neurofeedback and I ran into him at a conference and I knew he was new to neurofeedback and he started talking about the epileptic patients he was working with he was a supervisor I pulled up the supervisor and I said what is going on she said in fact I can't stop him I can't stop him but he's seen epileptic patients so all I do is try to guide him he has no idea how much harm that could do to the patient, to our profession to all kinds of things so you really do need to know what is your knowledge base don't venture out you guys will have our phone numbers by the time it's done I talk with other people that we're here people that are in this field want to help because as I say it's kind of a cult and we love bringing other people into the cult so we want to really embrace you we want to help you we want to guide you I have never called up somebody I don't have time to talk about them they may say how about you call me over the weekend or how about you call me tonight at 9 o'clock but never know so you can call up people um start with cases that are mild that aren't so complex ADHD is not mild and not so complex somebody walks into my office and says we want to do neurofeedback for ADHD and the answer is okay let's sit down I want to know what you want to do neurofeedback for I heard you say ADHD and it's like walking into a doctor's office and saying I'd like you to do surgery go back ADHD we know of four different biomarkers that we know of you train them wrong you're going to make things worse so mild symptoms then work your way out venture out a little bit start with your own kid that's what everybody does I think this point is very important that really decides for your experience and knowledge many people ask me there is diagnosis wise somebody that is not appropriate for neurofeedback what is the diagnosis that you definitely don't want to do neurofeedback and I really don't think there is such a case we know more or less depending on the research that we have there are disorders that we have more knowledge there are disorders that we know less right but I think really what you have to decide is you know why you know and depending on why you know if you can help this person that is looking for your help so it really is depending on your knowledge and your scope then you will decide yes I have the ability to help them or not and this is a huge responsibility to consider ok so this is what we are talking about do I feel competent to treat this patient right and of course if you are a newbie you don't have experience then you need to start with simple cases why you learn during your mentorship what are your goals you have very clear you need very specific goals with this that you need to set up with your patient what are really looking forward and ADHD or trauma or any other cases there the symptoms can be a long list but exactly what they want like if we can point to three main things that we can improve whether the main three symptoms that they are looking to get help if you think these three goals these three symptoms are you are able to help them then you need to see specifically the goals what is the what are the patient hope to see to solve this life right it's very very important to define the goals and the hope that the patient is looking and we have to be very realistic with them right we cannot say we won't be able to cure you we are not going to yeah if this is not a panacea we need to work we know that we can help there's a lot of work that has to be done but yeah what they are really looking forward and it's it's very easy for them to have very high expectancies it's very easy to I know I feel that this is going to solve all my problems we really need to grant them I said this is a tool we will try our best we will see how much we can help but yeah we need to be very realistic the patient is really motivated to make this change how much is a commitment that required for this neurofeedback it's a long term intervention it's not a quick fix it will take time we need to be patient if they are looking for the quick fix yeah probably medication will help them fast so that we really need to explain that they have to be patient to see the results and work hard and be commitment and then discipline half hour to an hour just to find the goals after the intake we want the patient to know and be in agreement about what we are working on and towards we use a rating scale we actually got something from Matt Fleischman as you know with him years ago Matt Fleischman has an ADHD clinic in Seattle and the goals are very precise I'll start out by saying if I could give you three wishes of how your brain would be different what would you like to see changed and I'm going to help you understand what I mean if somebody gave me three wishes I would like my brain to help me be more patient I would also like my brain to be able to not drift so much these are the kinds of things I'm looking to understand about you and somebody might say well I'd like to feel better you really have to help them narrow that down what does it mean if you feel better what would be different I wouldn't be depressed and if you wouldn't be depressed what wouldn't you be feeling or what would you be able to do how would your life change on a day to day basis if I weren't depressed I would be able to get up in the morning oh well that opens a whole can of worms because in the intake we would have talked about very detailed information about sleep what time do you go to sleep how long does it take you to go to sleep from when you start to when you get in bed how long does that take you I'm trying to understand do they get stuck on things can they transition are they watching TV what are they doing do they take you to fall asleep once you fall asleep do you stay asleep all night long and you know if people get older they'll be like well I get up to go to the bathroom that's okay can you go back to sleep after you get up and go to the bathroom if you get up and go to the bathroom four times that's not okay shouldn't be doing that and how are you waking up do you wake up okay do you wake up refreshed okay so now we'll go back to the depression I would be less depressed good what do we want to change about your sleep there's a good starting point and they're going to measure it we keep people journal you could and when I tap and how it's really not going to work I will let them use their phone but I want to get them away from electronics so I like to give them just I go down to Staples before school starts Staples has everything on sale and I buy like 50 journals you just put a label on them and everybody gets a journal when they come in but they write their goals in there and if they don't come back to their session with their journal that tells me something about how hard they're working and how compliant they are or it tells them they have super big ADHD or they're disorganized or it tells me something something important so is the patient committed to therapy we've already done a little bit of something above that but along the way we have to keep checking how do we check if they're committed to therapy I'll raise their abilities I'll tell people you could pro controversies we can get you Roman on this you can buy a home training program and you can work on it at home come back and see me two months later we'll make sure that you're doing it we'll check up on you but if you want to get more involved and we do neural feedback you're committing to say in an average of 30 sessions on the low side Because the people that come to us at this point are more involved. We also get a lot of adopted kids. We get a lot of chronic pain people that need a variety of interventions. So let's say 30 sessions. If you're lucky, it'll be 20. If mine felt 50, if mine felt more. If somebody says, ooh, I wasn't thinking that much. Well, how much were you thinking? 10. You know, I learned to violin when I was 45 to learn it. I still have to practice a lot and I still think at it. So that's not nearly as important as what you're doing. Let's look at if this is the right time in your life for you to do this. Maybe if it's a teenager, we want to wait till summertime, where they're not playing field hockey and not doing social club and not doing art club and not doing dance. We'll wait till the summertime. That's okay. Let's do this when it fits into your life. There are three components. There's finances, and there's time, and there's interest. So we've got to have all these components for what we're going to choose. And I'm perfectly happy if somebody does heart rate variability and decides not to come back. If we've given them something, they can help them. And you know how I love heart rate variability? So that's okay with me. Do they have external support? Is there going to be a husband at home complaining about the wife not cooking dinner because she's coming to neurofeedback? Is there a parent who doesn't really care if the kid goes to neurofeedback or not? And it's all the other parent? That's going to flop at some point. Not going to work. You know, do you turn them away? That's a clinical decision, but it's going to be a tough one for you. Sometimes we get parents where one of the parents travels a lot. They're kind of a nine. They're not going to get in the way, but they're not going to help. That's different. So it's not that you have to have everybody in the world on board, but you want to make sure that you're not going to have people that are in the way. Sometimes the first step is just to get people to where they can follow recommendations, where they can go home and practice the things that you're telling them, where they can get to their appointment on time. We have one person who's elderly who has some brain damage from stroke. He can't get there about 45 minutes into her session, but she doesn't have any family in the area. So we're going to tell her, no, we're going to work with her. We're going to try to get her to the point where she can, the first goal is get to your appointments on time. Are they able to follow recommendations when you make them? I like to recommend to all teenagers take a week off of electronics. When you can, let's pick a week, you experiment. Send out a notice to all your friends. I'm going dark for a week. It's a science experiment. They'll be okay with that. You're going to miss 2,000, you know, what, um, Twitter's and Facebook's and all kinds of things. But let's try it. Let's just see. This is part of an experiment. So I don't even say to them, you shouldn't do it. You shouldn't be doing it. You shouldn't be doing it as much. See, let's just experiment and then you decide. We will put them in control of what they're doing. A lot of the kids come back and they say, I like that. I like that okay. And I know how hard it is. We all know how hard it is. I haven't checked my phone since I've been here. I'm a little uneasy about that. And I'm like, you know what? The world's going to go on. If I was in a car crash, it would go on. So they can live without me for a day. As well as the recommendations from physicians, are you taking medication? Are you taking it as prescribed? Or are you playing around with your medication? That's going to affect any type of training you do with them. I think probably one of the, of the, of the, I can say tricks to help them to be compliant. Because we know one session will make a difference, right? Or five sessions. We really want to get a good amount of sessions so they can really feel and experience the improvement. So this is why many clinics try to encourage the client to buy a package of sessions, right? And this is not only for the billing purposes. It's so if they buy 10 sessions, they don't have their options, then go for 10 sessions then. So they will be more able to see the, the changes and improvements. And they will say, you know, this was worth it. Let's buy another 10, right? That they pay by session that it's easier that they can drop off. While I said I don't do free sessions, we did, if somebody had no idea what neurofeedback is, they didn't have any experience with it. They were scared about it. We would have them come back and meet with the technician for 20 minutes. And the technician would hook them up, put the brain waves look like on the screen and just identify some markers. Show them how you make muscle artifact, how that's different. So we would do that for one session for free, but otherwise I would tell people, don't come in for one training session. It's like going to the gym one time. Okay, doesn't hurt you, but you're not going to lose a pound. So if you're going to go to the gym, go to the gym membership and go twice a week. Go on a regular basis. Become committed to it. The same thing with the biofeedback training. Yeah, and let the client see how it's a session, how it's equipment, how it's required. They need to see the sensors and everything. We will talk about that. Is that me? Yes. Okay. So we need to educate that. So we are not only therapists. We really need to give a lot of understanding. And I was attending a lecture the other day about how to explain all these high-level physiology, neurophysiology to a client, right? And we really need to find the level of understanding. If they are a scientist and they will be eager to understand, in a molecular level, going that pathway, they will really want to understand that pathway. If they don't have that level, they use apples and orange. This is what happened. But you need to explain the mechanisms and the reasons and the research. And some people want to know, well, here is your USB drive with all the papers that I would recommend you to read. Or you know, I don't want to read. Can you refer me to a YouTube video? Yeah, there are some YouTube videos that can be helpful. So you need to really educate at the level of the client, because it's very important. And sometimes you can find the level right away. Sometimes it's hard. I mean, I say, oh, I think they are understanding me. I think I'm going to go a little bit higher. I'm going very good. Oh, their eyes look so clear that they are getting it. They walk out of the office, and the wife is like, great, what happened? No, this is great. I want to do it. Yes, what it is? I don't have a clue. So really you, so what I start choosing right now is, you know, what level do you want me to explain you? I mean, this is very complex, very easy. And yeah, there are people that they are so overwhelmed with all the information. You know, you need to keep it very, very basic. I always ask if it's parents, I want to know what they both do for a living. And try to explain it to them that way. And as much as possible, I try to get the kid to explain it to the parents. But they, there is a whole session before starting to educate, give them resources. And of course you will begin building up the relationship there and the trust. So it's very important. And all the process and consequence of neurofeedback. You need it to be committed. It's going to take time. This is what is happening in each session. This is what is required. You need to follow specific recommendations. This is how it is. So very, very clear. Have a checklist. Show them in diagrams. But very visual. This is where you have to be committed to do it. So, I think we covered a lot of that, right? Any questions about this stuff so far? We're kind of, we have a lot of experience clinicians in the room. So, things to add. This is a good time for us to share, I think, and really look at. We want to develop everybody's practice. So if you have pieces to share, please, please. Those that are working, you have come up with something good. There's something that you're like, boy, I'm pretty smart that I thought of that. And we want to hear about that. We want to include that and we want to share it. This is being streamed. So, please. Let me get the mic over to you. Oh, sure. So I'm not a clinician. How do you prevent someone like me who walks in your office and is, you mentioned fearful. You're messing with my brainwaves. What if you train wrong? And how do you reverse that? And how do you know? How do you know what you're doing? You can't see what you're doing. I know you have the wave thing, people that don't know anything. How do you address that? Yeah. Well, we explained that this is why we need to take all this time for the initial intake, initial evaluation. We want to learn as much as possible of what is going on with you. We can provide a neurophysiological evaluation, Q, E, G, E, R, P, and these are the tools that we're going to use. We're going to use the X amount of experience, right? And we need to learn also how you respond. And when you give us feedback of how you are responding, we are going to be able to address it in the direct way. So I think it's giving more information about evaluation tools and experience and resources so they can feel more comfortable and they can trust better in how we're doing. But it's a relationship that we have to build up, right? In trauma, it's very often. They don't trust you. At all. And what is that? And why this? And why here? And why that? And so you... I explained them everything. Everything. Every single sensor. What is made of? Why they are doing? Why they are measuring? What is in the computer? Why not? So when they are seeing that I'm really clear and transparent explaining absolutely everything, they say, okay, I think they feel more comfortable and more trust. I don't know. Yeah, I think personally for... I probably practice neurofeedback and biofeedback for at least ten years being a licensed psychologist but not being board certified. And somehow I made friends with the person who runs the board certification office and she really kept... Every year she would call me up on my birthday. You haven't gotten certified this year, have you? And I was like, well, no, but I don't need it. And she's a lovely, lovely person and she would say, well, you don't need it. But I think it would be good for you to have. Well, then finally when I got involved with the NRBS, I felt like, oh, this is a little bit... not good. You know, I'm representing an organization. I'm not just representing myself, so I need to become board certified. So I did that. And I think the benefit of it for patients is that I tend to go to a board certified surgeon and a surgeon who is not. I don't... You know, there's always that story of somebody with the bottom of their class, so somebody did the worst on the board certification test. We don't know if it was me. But I think if you have the endorsement of other organizations and if they're affiliated with professional organizations, we have somebody in town, in our town, that had his license revoked. And he practices neurofeedback because he can. And people will call me up and say, well, I live closer to so-and-so. Do you think I should go to him? I'm like, well, you know, I think you need to make that decision. Here are things you can look at. Look at their website. Look at whether they're board certified or not. Look at where they practice. See if you can speak to other patients of his. I have plenty of patients that are very eager to talk to other patients. Man, you get a mom and you help her kid sleep better. She'll talk to the whole universe. She wants everybody to come. We call it the mom's club. Yeah. Hi there. I have a practice in Plano. And one of the things that you were talking about in a minute ago about compliance and getting the whole, the parents on board, for example, if you work with children, something that I do that has worked very well for me and something that I've learned kind of the hard way through trial and error is, you know, initially, it was just about the kids and teenagers and building compliance and getting their parents on board because it's difficult to explain initially like that initial call about neurofeedback and biofeedback. You have to really hook them on that first call. Well, what I do now is I strongly urge and really 99.9% of the time I strongly urge the family to come in for an initial education training session with the patient. So whoever the patient is, if it's a child or a teenager, and even if I'm working with an adult, I strongly urge the spouse or the significant other to also come in and experience that initial session, a training session. So even if they're doing neurofeedback, my initial training session is heart rate variability. And I hook them up and I explain and discuss and talk just like what you did, the HRV 101. That's what I do. And it really hooks them because then the spouse, the parent, whatever, they're not the naysayer anymore at home. And then I've got 100% support. So it works really well to do a family session. Yes. Hi. I own a private practice as well. I've been doing neurofeedback since 2001 and been in private practice for about 10 years. And one of the things to answer your question, one of the biggest things that I find is to really do a good job of educating them about what this process of bio and neurofeedback is, especially with the neurofeedback. The first thing to understand is, I love their idea that these are sensors, not electrodes. There's nothing going into the brain. You really need to specify that. We're reading what's coming out, okay? And then the second part is, is that this is a training process. Yes, there is a potential you can over train. As she said, the six-year-old might go for 20 minutes and you over train. But that's not going to stabilize for very long. It's going to tend to fall back to the set point. So the way I reassure people is, is one session isn't going to make a huge difference. It's a starting point. It lays a baseline. We need to start somewhere. You got to get the first day to the gym to get the weight loss. But we can't do much. They can't be undone. And it's all training one-on-one. And we're just training what's coming out of the brain, not what's going into it. And that seems to help a lot of my clients to kind of settle down and take a deep breath. And then, as Kristi and others have said, if that isn't enough, I work through biofeedback first, temperature training, heart rate variability, et cetera, and then we go to brain training. And that seems to help. I think we've got four pre-season clinicians here that probably have all come to the same point on our own through, as you said, maybe not such a good experience at one time. We learn from our negative experiences along the way as well. We're like, oh, I'm never going to do that again. I've got to learn. I've got to learn. And what just makes me so happy is that, like, at this conference, we're talking about these kinds of things. Because I will tell you, you can go to a national conference and you are not going to hear this. You're not going to hear the nuts and bolts of this is how I failed, this is what I learned, and I want to share that with you because it wasn't fun for me. So I would say, you've got four people here now, all saying the same thing, bringing in the family. I don't do an evaluation report so when we do quantity each I say to people, please don't come back for your results alone. Please bring somebody. Right there though, same thing. Yeah. Must be, must be something that everybody figured out one way or another. Yeah. Yeah. Continue with why you have to disclose with how all the procedures, it is dangerous. It is a great explanation. It is not, it's safe. There is not much that we can do in one session that we cannot do. So, it's very important here to show evidence-based data, right? If they are looking for whatever disorder, you have to say the research is showing us this much. But we don't know this much. Okay? And we have to be very clear what we know and what we don't know. We cannot be blind to the client, right? If it's a disorder that we don't have much research. So, you know, like evidence-based, we don't know much, but probably you have clinical experience in that disorder and you have treated 20 patients with that so you feel very comfortable and say, research, we don't have much, but my experience is very rich and I have treated X amount of cases like you and I feel very comfortable doing this. So, this, it is dangerous. It can really help you to give the evidence-based information and also it will work in my case, right? And this is all that we have to disclose. All the criteria or the inclusion criteria they are going to be good candidates or not. This is a long story about insurance. Do you want to talk about it? Do you have work? Well, what's every state's difference? So, I understand Texas covers biofeedback for concussion? Sort of? Sort of. It's very... I think... It's over here. Can I have all of you come over here and help some video folks out that they continue from last night or night? And while we're walking together what's the thanks for video folks that we are getting experienced in the world? I've had quite the turbulent experience in Texas with being in network. So, I got in network with Blue Cross Blue Shield in United Healthcare thinking that it would help. And Blue Cross Blue Shield would cover the CPT code 90876. If anyone's familiar with that? 90876. They said they would and initially, kind of sometimes they would cover maybe the first 10 sessions or so. And so my clients were coming in twice a week. And then they decided, oh my goodness, I don't want to cover this anymore. So they just stopped paying. And this happened over and over and over again with my Blue Cross Blue Shield clients. So I said, well the heck with this, this is not working because they're not paying me and I'm working for free. So I got out of network with Blue Cross Blue Shield which was the best decision I ever made. Well I also got in network with United Healthcare and I still am with United Healthcare. They were a little easier to work with. But the CPT code they covered is 90901. They're starting to do the same thing with me right now. So after my clients have had so many sessions, 10, 15, they start going, wait, what are you doing? And then they decide it's experimental. All right, that's what Blue Cross Blue Shield was saying too. It's not experimental. So we're not going to cover this anymore. So then I have to talk to my clients. It's very awkward for me as a clinician. And I have to talk with my client and say, I'm so sorry, they're not covering anymore. Then my client gets mad and they call and it's just this awkward process. So I'm now strongly considering getting out of network with United Healthcare. But those are the only two carriers that I've had this experience with. It's different by each state I have spent many, many hours on the phone with insurance companies and trying to help clients. I'm in several networks. I'm not in a couple. So like in Pennsylvania, I'm not in the United Healthcare because they're very difficult to work with in Pennsylvania. It depends what state you're in. But also, if I was to say, if you want, I'll be glad to send you my form that I spent many hours developing that I give to clients and have them call their insurance company. I started that in January of this year and clients will come in and say, hey, call my insurance company. I was on the phone with them for an hour. Yes. And I think that's part of our responsibility is to not protect our clients. We're neurofeedback providers. Insurance, by and large, doesn't cover most of it. And that's, in a way it's our fault because nobody's, you know, approaching the legislature for that. But I'm going to talk about that in a minute. However, it is the client's responsibility to know what their insurance covers. Okay. So if you like, I'll be very glad to share that form. They call up. It's got a step-by-step. You look through it. You modify it how you want. I don't care. I'm happy to share it. Last week, Joy Lunt did a presentation for AAPB. Did anybody listen to that? Okay. She was very thorough and very clear about how insurance is work. Boy, there's a backstory that I never even dreamt of. But I believe, and I hope I'm not speaking incorrectly here, I believe AAPB is actually going to offer that for free because Joy's takeaway message was if we don't build the insurance companies for 90901, they don't recognize that we're doing it. And if they don't recognize that we're doing it, then they don't recognize that it's something anybody wants and so they really don't care. So that's very different from what we have done in our office. We have actually built people for an office visit and then confirmed that their insurance does not cover for biofeedback and we charge them out of pocket for the biofeedback. If you're going to do that, you have to have them sign a waiver because once in a while you're going to get a client that's going to call their insurance company and say, do you know that the SADARS are charging me a copay plus an additional fee? And then what happens is the insurance company calls you up and says, hey, your client's complained. We want to verify that you're not charging them extra. And I say, I am. I'm going to send you the form that they signed where I explained to them this is not covered and it's additional fee. And the way I explain it to the clients, if you go in my office and I do a therapy session with you and then I take you into the other office and I paint your nails, your insurance is not going to cover it. And that's how your insurance thinks of biofeedback right now. Sorry. So you have to paint. You have to cover. You have to pay for what I do that your insurance company doesn't pay. But Joy's message was, no, bill it. Bill it, get it rejected so the insurance company's now. I have quite sure AAPB will be giving that out for free. Those that listen live are paying for it because we got CE but they want that message out. Any questions on that? Because boy, that billing is tricky. Okay. Okay. So here's just something, you can have a slide. This isn't a way to explain to clients. The background picture here was chosen very precisely. Start with something easy. Don't, I don't have a head on there with sensors. I don't have an EEG cap on there. That's a little bit scary if you don't know what you're talking about. But three, two sensors on my fingers. I guess I could do that. So it start explaining very easily and then work your way up. Well, explain of course that there is a lot of modalities that we can use and regulate physiology and what is the application of each of them. What are the things that we have to begin with? What is the purpose of the combination of these? Right? Like really explain then the broader umbrella of the interventions and the reasons and the applications. Again, you can take any of these pictures. They're not copyrighted. Print them up. You can just pull them off. A lot of people are visual. You know, they're visual. They're auditory. Give it to them both ways. But people get confused. Well, what's biofeedback? What's neurofeedback? Neurofeedback is biofeedback. Let me explain it to you. No. That's mine. Okay. This is just our explanation of neurofeedback. So brain waves have patterns. They have rhythms. I draw for them. I pull out of these paper. I'm like, look, we call these squiggles. And if I draw them like this, they look nicer than if I draw them like this. If yours are too big, that's different than if they're too small. You could take out a crayon and do it. It doesn't have to be very sophisticated. But we want the squiggles. We want the patterns to go in a rhythm that's best for you. If you're an artist, it's really good to have super high alpha when you close your eyes. Not really good if you're a trauma patient. So we don't want to just train so that you're like everybody else. We want to train you so that you can do more of what you want to do. And ultimately, you know what we want to do? We want to train you so that you can access what you need to access at the right time. So right now, we're all capable of walking or running, but none of us are. Because that really wouldn't be very good if somebody was standing up in the aisle running right now. But we all know we can. And that's what we want to do with your brain. We want it to be able to sleep when it is supposed to sleep, focus when it's supposed to focus, and drift when it's supposed to drift. Examples, again, I think for some of you, for many of you, this is going to be very redundant. So add your own examples. I appreciate that y'all are contributing. You say it a different way. Somebody else in the room is going to hear it better than the way we say it. But physical exercise, you know, again, my violin is an way of saying, you know, you need to practice. You need to do, I can't just practice once a week. If I do, then it's like I'm starting all over again. And guess what? If I have a bad teacher once in a while in there, I want to try a different teacher, they're not going to make me any worse than I am because I'm going to figure it out. This is where the patient relationship comes into play. I am smart enough to know if my violin teacher knows what they're talking about and I'm not going to stay with them if I figure they don't know what they're talking about and we want our patients to do the same thing. Yes, try to use examples that relate to them, right? So they can understand it better in their own experience. Explain them that there are different rhythms that represent different states that are related with different dysfunctions or dysregulations of circuits. And this is very important that they understand that this is what we're going to train and the meaning of the frequency. So actually in the charts usually when we record a QEG this is part of our results before explaining the maps we go over each of the frequency bands so they have very clear what they mean and also because there are words that they will hear during the training, right? We're doing alpha, beta, what that means. So this is part to add to that. There's somebody I do consulting to help people with practice development and there's somebody that I was working with and one of the things I do is say pretend I'm a new patient I want you to I'm going to sit down and you give me a first session and this person hooked me up and turned on the computer and started running and I was like whoa, wait a minute what are we doing? As if I'm a patient and he says oh just sit back and relax we'll do it and I was like wait a minute what are we doing? Are you doing anything with my brain? I heard of brain waves you don't need to know about that let's just go so we had a long way to go we kind of had a couple of struggles back people want to know people want to know and they deserve to know you always use the word learning never feedback this learning okay so always use the word learning self-regulate is also a good word to use link to biofeedback where it's a learning procedure it's basic basic learning theories and why some brains respond different to another because we learn different right and this is exactly what we would like to understand better and even that we kind of predict few fundamentals with the neurophysiological testing how fast or how slow we will have results but in reality we don't know how fast will respond until we start doing the process and it depends on the learning process different speeds number of sessions you will hear different different stories from different providers the most common is not minimum of 15 or 20 to 60 some people do even more of course depending on the severity so this is really depends on the clinician and the experience you will see how fast I will see the changes right so what I usually say to the patients is most of the times you will see some changes between session 5 or 10 definitely by session 10 I really need to you to see a light even that it's intermittent light but we need to have a light that we're going in some direction we're not seeing any light we are we need to review what we're doing right but this is most common how fast they will see the changes in this term some people is very sensitive they have changes in one session right and hopefully changes and they have to be adjustments of the protocol during the training depending on how they are responding and there are ways that we can speed up the learning process adjusting our protocols and procedures and always you need to re-evaluate right and see use as many tools when you have an initial intake not only if you use QED but clinical scales it's standardized clinical scales you always never just group the client up and you don't have a baseline of what they started whatever you are treating is oppression run a back inventory or anxiety scales like whatever standardized scales that you have more measures of what are you doing how they are changing but something else here no? hear about the number of sessions you will read some authors talking about 200 sessions right and yeah this is exactly what we don't know I mean how much our brain can change and how much our brain can learn okay we know our brain is plastic we will keep learning but just understanding the basis of learning and the area of neuro rehab we know when we are exposed to new stimuli and new learning or physiology tends to change pretty fast at the beginning and then we reach a plateau right so what we can do that we need to switch the protocols and do something new and different so the brain keep learning and when we think we reach like a maximum about the switching that we can do we definitely need breaks to consolidate the learning and if you continue doing it you have the consolidation of the circuits and the learning and apply it in real life so this really continues happening so breaks are very important instead of continuous training nonstop training okay so will it work for me it works for many people it works for most people but I need your help I need you to manage your sleep I need you to work on managing your diet I need you to work on managing your exercise your physical activity that's a tall order so we don't need you to do that all at once let's start somewhere these are all the things that you can do to contribute where would you like to start what's the one that's easiest for you could you go to sleep an hour earlier or a half hour earlier could we start there so there's a lot of negotiating and as Deanna said but I want to go backwards because I said no but I meant yes so the feedback what's their feedback re-evaluation re-evaluation we think of as you know maybe doing assessments but we have to re-evaluate all the time every time somebody comes in we go over their rating scales with them and people get tired of it and I know that and I'll say I know you don't think this is important but I'm going to ask you to give me your ratings again so we'll do rating scales something like I'll make things up for a child number of meltdowns per day or as well as we do we try to do five so it might be intensity of meltdown might be how long it takes to get to bed and every time they come in okay let's go over those ratings again so how many meltdowns did we have since you were last here we had two and we'll mark that down if they were here three days ago we mark that down as three over two in the last three days they had two meltdowns on the average how long it takes your son to get to bed oh about 30 minutes let's double check you didn't sound confident about that what do you have in your book let's look back in your book oh I forgot my book oh good that's a good thing to help me remember to remind you you don't want to reprimand them but it's like oh good that helps me thank you I'm going to remind you there are different tracking locks that you can individualize for your client for your practice and also identify why it's easy for them for trauma clients if I give them a checklist of 20 questions that they cannot even understand what we're asking of course is one line right and yeah you need to individualize how they keep the track for everybody I like to explain a lot about different regions of the brain and different functions of the brain when we explain if this will work for them or not and say well I mean you have a reading issue and we have an area of the brain that is particularly or the priority of this region of the brain is to learn how to read and write right so if we find this correlation with your brain map we know exactly what is the function and the frequencies that we need to regulate for this difficulty that you have in life so I use a lot the different areas for education and explaining them how precise we can be and they will make more sense for them does anybody here use the off-mer method does everybody know what the off-mer method is does anybody want me to go over it go over it okay so Siegfried and Sue Offmer are their son Kurt have a company and there might be other people that are partners or owners in the company called EEGInfo EEGInfo.com Sue was very involved with EEG Spectrum back oh I don't know I'm going to say back in the 80s late 80s maybe maybe somebody can correct me does that sound about right and Sue is they actually came into neurofeedback because they had a son that had epilepsy and they got involved in that regard with Barry Sturman and with Howard Lightstone who ended up owning EEG Spectrum that is now called EEG Education and Research okay so Sue is a clinician and she's a very intuitive clinician and at that time the original training for epilepsy was CZ that's it train it CZ and my understanding and if Sue ever gets hold of this video that's being produced and she wants to correct me I would be glad to have her change it but my understanding is or anybody else in the room is that Sue started to say you know I think we can train a little left and we can train a little right and people in the field would say no no no you can't you shouldn't do that Sue's very intuitive I've actually been trained by her she did a very nice job with me she honed right in on what I needed but the field was fairly critical of that there's no research there's no research you shouldn't do it and so that but then what happened was the research came and the research supported attention left emotions right and then Sue said you know I think we can train a T3 and T4 for we can get to the temporal lobes and we can get to other things and the same story happened the field said no there's no research and Sue said I'm going to do it and she did it and then later the research supported her and then Sue said something else and the field said no and then finally Sue said I've had it with you guys I don't need you I'm leaving and she and her family went off and they made their own company and they partnered with in fact the engineer that we're partnered with with HBI with Bernard does their equipment he's in Switzerland and he's from what I understand an excellent engineer his former job was he worked on the EU satellite system and he had a son who is who needed neurophobia back training and he saw our amplifiers and he's like I can make a better amplifier and he did and so he made the amplifiers for the afmers which are EEG info their method is symptom base no assessment so symptom base is first of all do no harm and then start on the right side of the brain if you need quieting and calming or inter hemispirically if you have instability headache migraines sleep disturbances not falling asleep but interrupted sleep epilepsy things like that and they have not published research which is why they're not accepted by BCIA because BCIA is research based but they have done studies they're not published and they report good results and I have used their systems I own a couple of their systems and for some people it works very well but so as we're talking here about assessment assessment they still require assessment but they're not measured assessments they're symptom based assessments how did you sleep what's your personal information that you can give me about how you did yeah anything if anybody can add to that because I do not want to misrepresent them they've been very good contributors to the field yeah and I we understand many clinicians don't have access to QED it's expensive it needs a lot of resources to get trained understand interpretation et cetera but we know is very valuable if we really want to help this patient in really in a significant way definitely with severe cases you need to understand better and better and in detail what is going on in this brain instead of taking the risk of doing symptom based right I've been working with people that has been doing symptom based and now they are trying to so they are switching to QED and I asked them why do you will train if you wouldn't see the QED what's your decision based in that well I will do X and J and this is what is my plan and I showed them the Q and said you will know you know you will do exactly the opposite is needed you will reinforce frequencies that are already high and you will increase the symptoms and you won't help this patient so I think even that I know it helps a lot of people and it's at certain level acceptable this type of practice it will help us as a discipline to be more reliable in neurophysiological information to be more to have more evidence of what we are doing and all these symptom based protocols we have a higher risk to not have effect or have side effects and this is why at some point the discipline was very not respectful right and this doesn't work and we don't think this is a good intervention so I think this is helping us to go to another level and yes it requires more but it's worth it this is what we want to to be this is what we want to provide and make a difference so this is a objective of this new project are we going to talk about this? I think we'll wait till the end and see if they want to see okay or I don't care okay well well we have been working in a project to go even higher than just QEDG evaluation we're trying to integrate ERP in the neurophysiological evaluation so we are collaborating with the human brain index database and we are trying to help more clinicians to offering the interpretation and recommendations of the QEDG and ERP so they can provide more not only neurofeedback because the ERPs give us another level of psychological understanding and we can recommend other therapies that can be more that more successful with this particular client so and of course well Andrew Mueller at his group they have been doing this research for how long 10 years and they are trying to find the biomarkers of the ADHD right and they they are very close having a lot of very interesting data my husband and I have lots of conversations about this because my husband he's a psychologist and we've worked together for ages it seems like there's lots of husband and wife teams in this field like I said it's a cult but he is somebody who doesn't like to go with the status quo he doesn't like to be pushed by establishment he doesn't like to follow rules and so when we first started you know like I said his first neurofeedback system I think cost $12,000 computers were still expensive it was impossible to get EEGs who owned that and so we did not do them and so for a long time he would say we don't need to the QEEGs rather he would say we don't need to do them we used to do fine without doing well that's true that's true that's pretty good but now do we have an ethical obligation if we know about this if we know that we can get this additional information realize our ethical obligation to be able to convey to the patient why we're making the choices and what other choices are available to them it's a tough answer there's not everybody can afford to have a QEEG system in their office somebody had mentioned earlier not every patient can afford it that's true but I want to tell you even my patients that are on medical assistance get their hair straight get their nails done and go to Disneyland and I don't know how they do it but most of them I figure are going into debt to do it and if you're going to go into debt for something this is a pretty good thing to go into debt for that's my opinion but they need to choose but I need to choose am I going to offer the service without the backup that I feel I need and sometimes I don't even feel like a Q is necessary so I don't want you to think I'm always like okay you're here good thanks let's do a Q that's not the case if somebody is so dysregulated like let's use the optimal method and let's just quiet your brain down or let's do HRV and cognitive system let's meet you where you are but if you have these expectations of me to help you you also need to let me use the tools that I have available to help you with you me you do I feel like I'm talking a lot okay so I can talk so I think we mentioned all of this right all the things that they can help us so I always say you know this is a teamwork we're only going to help you in one direction but you have all these lists that you need to help us and more as Christi was saying about with children to be the two parents present and compliant with all the things that they need to work at home because it's very very important nutrition and a big advocate about nutrition a big advocate about nutrition many many times if this kid is not eating healthier we don't even start the procedure they are going to eat just junk and pizza I don't think it's worth it we won't be able to help them so it's very important to give get very deep in nutrition and explain the importance this is neuroplasticity we are going to help to produce new neurons connections and change the chemistry of the brain we don't give the ingredients for this to happen the amino acids and the minerals and everything that the brain needs it won't happen it just won't happen and I have very clear cases of patients that are following healthy diets and patients that know I can see the rates so different how they can change so actually when I have very good clients doing the nutrition and I see the improvement I know probably half of it was just the nutrition and the other half was the neurofeedback so I'm very very strict with the diet because it really makes a difference what are some basics that you recommend? well just have you just have balanced meals balanced we should have a slide of that have balanced meals try to reduce the just high carbohydrate smells right and more breakfast anybody knows about breakfast how important it is but balanced with healthy protein in three meals a day and how the snacks don't live without food more longer than four hours always healthy snacks fruits, nuts other combination of healthy snacks try to avoid or eliminate what we know what I always tell them I have a list of recommendation nutritional recommendations this is nothing that you don't know this is not black science or a secret this is common sense we should be eating like this everybody so this is not something new I'm not telling you something brand new so try to avoid what we know is not good excess of sugar excess of salt junk food and try to reduce the highly intolerance or allergenic food like gluten and dairy and just with children they say well but they cannot have a candy or a chocolate they say no it's not that they can't just don't have it at home in their table for every time they went to snack chocolate right or junk just have them in a special location where they go out for the weekend where like a very outside house that it's not something that it's in the regular diet definitely soda right and highly sugar drinks and I do recommend some supplements basic supplements that you probably all know like omega-3s vitamin D and multi-mineral and it will be ideal to have levels of vitamin D before you recommend vitamin D but I mean we almost everybody is low in vitamin D so just does it for the it will be very nice if you can help you can support have support about nutritionist so they can guide you very well in what type of supplements to give but you know there are a whole nutritional base intervention that can go along with these conditions if you're licensed and your license doesn't allow you to prescribe nutrition you can't but you can say to people something like there's a lot of information on the internet about omega-3s and how they help your brain health here are some websites you can go to and there is in fact a lot of information about omega-3s and then people will come up with oh I found an article that said you shouldn't take omega-3s omega-3s for brain health is different than omega-3s for heart health and so for heart health there are some instances where it's not helpful if somebody has a pacemaker if somebody is on a diuretic if somebody and that's not even heart health or if somebody's on oh anything like Lipitor or statin please don't you be the one to tell them to take omega-3s much easier to say it's easy to look on the internet and look up information about how omega-3s are helpful and I suggest that you ask your doctor if there are any contraindications that you shouldn't be able to take it yeah they can they can't refer to their general practitioners because this has very general supplements and they can ask the doctor or have a nutritional consultation that can help on nutrition here's a suggestion for everybody leave here today and go to McDonald's okay go to McDonald's and buy and print and put it away and pull it out in a month and it will look the same as my McDonald's looks now and I've had it for three years and that's I can knock a kid off at McDonald's in two minutes I pull it out of the drawer and I say this is three years old and not a single fly went after it not a fly not a maggot nothing it's sitting in the drawer would you like a bite? okay because there's so many preservatives in there it stays preserved forever and the paper is getting ripped but the burger looks pretty darn good yeah and actually now that you mentioned McDonald's I remember I claimed that I was in your office this kid arrived he's he's yeah he's priced to come to session so the parents came in the kid like smelling McDonald's I was right there in the office McDonald's so I started asking more about the diet of this kid right and how many fruits today he has and the kid and I asked the kid no the parents how many fruits today you have eight year old he's thinking very hard and she's like I think I have a banana like a month ago so that was really scary I need to pull in the parents and I was like this is I mean the case is serious his brain is really very very dysregulated we need to do something else and I teach them just few things start offering some fruits just begin with that and they start having one apple a day and little by little and they start switching definitely when this kid was able I wouldn't say ideal healthy diet but eating more variety of foods less junk and processed foods this kid did better so it's really really very dramatic to see exercise is very important that the people if possible they are physically active just because of all the knowledge we have how exercise can promote neuroplasticity so it will just enhance what we are and electronics Angelic is a big advocate about avoiding electronics especially before we don't allow it in the waiting room I actually there are actually these things that you can buy cases that you can put your phone in that like prevent it and now I'm like getting crazy about the EMFs and what they do to little kids brain again if you want an article I'll send you an article on the EMFs but the brain needs to relax you train Diana was talking about consolidation so training doing anything doing heart rate variability doing EMG learning how to relax your muscles doing neurofeedback and then you leave and you go on your cell phone why did you even come it's like going to the gym and then going out and buying ice cream who does that so we actually don't allow electronics in the waiting room for patients now I don't feel like I can tell parents that are driving their kids they can't go on electronics they can't be like the total boss of electronic world but for people that are training we have a sheet that we give them at the beginning of training these are some things that are going to help your training and we're going to ask you to comply with them so even kids get in the car and on the way home they're watching video games why did you drive an hour here to do that drive home and listen to music or something so yeah sleep try to advocate for good sleep and training neurofeedback it requires sleep to consolidate the learning everything that was learning neurofeedback session it will happen all the changes it will happen during sleep so actually if your client has the flexibility to have it in their schedule I recommend it possible to nap after the training this evening goes straight to bed so it really helped to to consolidate the learning so definitely the day that they did the training hopefully they have a good night of sleep and they try to take care of having more hours of sleep very important the structure at home at school so many many times we need to do family intervention consultation with the parents to see how their strategies for raising the children and educating the children so they really understand whatever they are doing is helping in the pathway because many of their education resources is actually the opposite so we need to learn how they are doing and this many many times it takes a lot of effort from the parents so parents needs to be involved if the children is a client and it's hard for them yeah sometimes they bring the kid and the kid is a problem here is the kid I run sometimes they send an enumer we don't even see the parents they were like no no no no this is not how it would work just the kid is a reflection of many things that is happening in the dynamic of the house so we need to do an integrative approach with the parents and very important also with the school many schools don't know how to help them yeah and this is very good some teachers reaches and they say what do you recommend me to do with this kid because I don't know so it's really very good to have everybody connected good communication and everybody has the same goals and other therapies neurofeedback biofeedback it's a enhancer of anything else they are doing in terms of other therapies is not instead of other therapy okay I'm doing neurofeedback I'm just talking about neuro rehab world I'm doing neurofeedback I stop doing speech therapy so no it's the opposite they're doing neurofeedback you need to do more speech therapy because this is how we will help for speech therapy to be more productive efficient the same with trauma the neurofeedback doesn't mean you want to do therapy you need to do it I just explained that this is like it will help us to speed up the process with other therapies it's not instead of so it's actually the time to spend more time resources and money in doing more therapies so they can they can move forward faster faster are you starting to get the picture you got to lay a really good foundation so like I said that clinician that I was working with didn't have any foundation and I probably go to the opposite end we you should have a website a resource or a website that you direct people to that's okay for the longest time I use my Coleman's website I don't have a website go to this one it's good so I know this stuff will take time you're working a lot you're saving you know come to conferences you can't do everything most people can't but we want to provide personal experiences tell them your own story how did it work for you if that's not comfortable for you you can tell them without revealing information information about clients and how their progress went or stories that I told you I went to this conference and somebody told me this so it finds you a level of comfort as a clinician but you want to help people make the decision about why they want to pursue any kind of biofeedback training or not updated articles I still refer to ISNR has bibliography it's probably not totally updated but it's pretty darn good Corey Hammond started it years ago and it's got it's it's sorted by on face symptoms so anxiety seizures everything's on there what's that SMBN it's a Mexican book oh it's a Mexican book sorry sorry so de-animate de-animate the PowerPoint I said I'll finish it up and I'm like what's that this was for a lecture in Spanish so I forgot oh okay poor clinicians the Thompson's have put a lot of effort into the neurofeedback book now they've refined it man it's a it's a heavy read but it's got everything in it and there's millions of books out there I you know I read the Swingle Book on the way out here because I had a layover and I could finish a book so you just pick up stuff little by little but there's books for clients there's Paul Swingle wrote a who wrote the book oh gosh I just have them in my office I pull them out I can't even think of the names of them there's a book on ADHD I don't know I don't know the names of them I have them handy I can't think of them it's a green book they've been doing a part of that it's this color green on the front but at any rate I can get you that list send them to other websites have brochures have stuff in your waiting room BCIA or AAPB I'm not sure which one it is ISNR they all have brochures that you can buy put them out give people will ask you questions about them you don't you don't have to explain everything they'll come to you with questions oh and something very important about testimonies that has been very useful lately there are clients that when they finish their process and they are very happy with the results they are open to whenever you have a new client they want to talk with a client that experiences add them to call so I keep them the number and they talk to a real person that just went through the process so this is a very good information that they can get not only from the clinician okay so different clinics have different procedures a process what is what is first what is follow so this is what we more or less we do the same we first have the first interview you can do it differently part with the phone part of course always in person but always you need to spend some time as needed really to explain all education explain all the procedures answer all the questions so everything is very clear initial evaluation it includes different things for different clinics but of course in my case I able to do a full medical evaluation neurological evaluation neuropsychabao you can do that smaller as large as you like but definitely include the the main symptoms that you are targeting QAG evaluation here we need ERP and with all this information we produce initial report so we have we spend a session explaining the findings of the report this is what it looks like this is you this is your clinical symptoms this is your subjective measures these are your objective measures your neurophysiological evaluation this is what we propose you to do this is a treatment plan we predict that this amount of sessions will be able to help you in this frequency this protocol this protocol this protocol and these are all the other recommendations that you have to follow along so these reports are pretty expensive sometimes how many pages 35 or who knows so really spend the time for them to understand as much as they can explanation of the findings individual sessions of packages I think we explain that and adjust the prices if needed we talk about insurance do you need to talk more about it no? we talk about this the symptom checklist all the symptoms in different domains as you want to we have these hanging up in the waiting room and we ask the patient to fill them out before their session starts so it's a lot of paper but some people just skip over them and we start to realize that but some people take them very seriously and we want to let them know that we're serious about the information that we need and it's very important to track symptom changes because with their feedback the progress fluctuates a lot they see improvements they don't they see improvements they don't and they can have this and this is normal this is normal progress so whenever something's going good that's great we're all happy we have all documented we have a bad day something is going down and they will come very upset with you I'm not seeing the result this is not happening I'm still having this issue I say wait a minute we're in progress last week you were here yes we have a fluctuation but it's fine we will go back again and every time we go up we'll be higher so this is what's happening and if they don't see that we keep a record of it they will forget the good days they will come and tell you only the bad day if it's a mother with a difficult kid they will come and tell you only how hard it was to drag them to the session and this is all they know but we keep record look he has been sleeping for four days and you got a good note from the teacher so you need to remind them because they easily forget the good things so keeping track is very important so they can visualize it and they say okay that's true good things are happening and more things we've been talking about the therapeutic relationship all along but we put more slides in because we really need to stress how important it is that doesn't mean you have to be available all times a day I think it was since I was here somebody was saying that they don't answer emails or something like that outside of business hours and their patients know that that doesn't mean they're not cared about but you need to take care of yourself as well but on the other hand when somebody comes in again this is routine for us I love my job I'm lucky I get to go there every day but it's not the most fun place for most people to go to so what we contribute to their being with us it is very very important we care about them now it's interesting because my daughter is a personal trainer and she knows much more about her clients than I know about my patients in this sense she knows where they get their nails done she knows where they went out to dinner she knows all their social stuff I'm like wow I don't even know if my patients go out to dinner like that's interesting but what I want to know is how are they feeling in their skin and how am I helping them feel as well as they can in their skin when they come we have coffee, tea, water in the waiting room I would love to burn essential oils but we have enough people that are sensitive so we don't do that what are other things that we do I mean we just we want to make it nice for them we have tissues everywhere I spend a fair amount of money on tissues it's okay you're not that expensive I mean buy a lot of tissues lots of boxes we want them there we want the people to feel comfortable we actually do have one of our staff has a therapy dog and I can't tell you how much patients love that I one out of a million doesn't want the therapy dog in the room something that Christy was mentioning that this is very important that she encouraged all the clients to come and visit the office to get all the information and this is so important so they really see you they meet you they get your vibes and energy and everything they need to feel that they will feel comfortable in your hands so all the empathy and all the things that we provide in this first consultation is so important so they can feel comfortable that they will trust you and they see that you care about them right and when they see that you are really caring and really listening and really spending the time and I mean these people come from the world where 15 minutes medical consultation and they didn't look at them right so oh wow they are listening to me they are taking care of me so all this is very valuable and very important very important to have a successful effect do you know if you go to home depot try this walk through home you have home depot right I mean everybody has home depot is it from Texas? I don't know walk around home depot for 10 minutes 5 people will say hello to you they are trained really good no that's just a lie huh? really? oh by us? oh my goodness you cannot walk in home depot that 5 people don't come up to you and ask you if they can't help you they make you feel so welcome there so without me it's pretty big okay bad example but when somebody walks in our office whoever is sitting at our front desk first time especially hi nice to see you did you find us okay? did you get here okay? we were waiting for you no matter what you're doing okay you don't have to jump up and give them the paperwork right away I'm in the middle of something can I show you where the waiting room is right over here would you mind waiting there for me because I'm looking forward to showing you something it goes a long way how many times you pay attention like Diana said when you walk in a doctor's office and they're like they don't even look at you that can go a real long way so that's part of what your placebo effect is yes we know with biofeedback neurofeedback we have a huge placebo effect right and this is related with the relationship with the therapist and how much it is or not well this is something that we have to explore in research but and not only neurofeedback I mean we have very decent research about a medical treatment how the medical doctor prescribe you the your regular medications if they really take care of you and talk to you and look at you and you will have better respond to taking that medication that if not so this is very clear data and for us it's even more more and more important so the relationship with the therapist if it's a technician doing the session they need to build up this relationship and I vary against of the offices where they run simultaneous sessions with one technician so they just hook them up and they disappear and they review it somewhere else and they are just along with the the screen you are losing probably 50% of the effectiveness of the session because they need somebody besides you guiding you what you are doing are you doing right or not it is work if not and all these will help to have their effectiveness of the session so this is huge the relationship with whoever is running the session and well especially in trauma because in trauma we need to be aware if they are dissociating or not they are having flashbacks there are many many risks that can happen during a session that we need to be taking care more? oh sorry well I was thinking about what you were saying so I'll add to that we do that too when I visited Angie Mueller for the first time he actually has he doesn't have his clinic anymore but he had an office here and then a window here and an office there and we built a window in there and we never used it because I just could not pull myself away to be like I'm going to go check on this I'm going to go be with this person while you are here training but there is somebody I know was one of my teachers and that is how he runs his sessions and he gets very good success but what I'm also going to tell you is we'll go in Sunday morning at 9 o'clock to train somebody everybody has his personal phone number you can call him at 11 o'clock at night so boy you know he cares so that he's got ADHD and I would say that if he was he would have said it if he was in the room so he can't just sit in a room with somebody for 45 minutes and he has trained he's got ADHD and that's the end of the story so that's how he manages it so what we are saying I hope while it might sound very pedantic that you also understand we understand put your own personality and your own heart and soul into it and do what if it's not right for you it's not going to be right for the patient so while we're giving you guidelines you have to find exactly what's right for you and how it's going to work and also if they have or a technician assigned try to keep it consistent trying not to switch it all the time and have different people because this relationship needs to build up and of course if for one session or so it has to be switched the patient needs to know in advance they won't see their technician or therapist because they need to approve it you want to come, your clinician is not here today or we postpone the session because it's very difficult that you go up and say somebody else is going to see you and I don't know them and how I'm going to fill with them and even that we have very standard procedures on how to run a session everybody has different things and these different things can yeah change the experience so while this is what I was saying that even in medicine, ultrapolitic approaches the more you will be able to take care of the people if you care okay, I think we reached the end yeah, so I think what we would do here is we'll entertain questions if there are more that needs to be done for the society and if you like, we did finish a little earlier the trauma went a little bit fast we have an evaluation and we can go through a functional EEG evaluation so y'all, I'll leave that up to you Art to kind of we've been going for about an hour and 45 minutes if you want to take 5 minutes, think of some questions and come back, you all want to do that? yeah yeah a break, good that will be good okay okay okay okay okay okay okay we're going to play a video during the break that's just an advertisement that we've got from a sponsor so BSTX does not end during the break so you can have some information about what they offer I'm Dr. Mary Tracy I'm the director of Northern California Neurotherapy for operation for about 6 years in Davis California and we provide diagnostic assessment and neurofeedback and biofeedback training for psychological emotional and brain trauma disorders everything from depression anxiety and attention deficit disorder to more serious problems like traumatic brain injury my name is Kelly Nelson and I am a licensed marriage family therapist I am Mary Tracy's colleague we work together we teach together we consult on cases together we do training together it's been really enjoyable to move into this area of work like any conventional medical process you have to start with a diagnosis before you can do a treatment and our diagnostic assessment involves placing electrodes on the scalps of people's heads and recording brain activity we record the brain activity and then we process it digitally with very sophisticated software that gives us an indication of dysregulation in the brain we have these huge databases of so-called neurotypical brain activity so we have a control group basically and we statistically compare the patient's brain function to that of sometimes age matched normal population matched neurotypical controls whenever we find something that flags high or low those areas become targeted areas for treatment and the treatment involves neurofeedback which is a learning paradigm we use videos, video games and music as the media and what we do is have someone sit in a very comfortable chair we record brain activity from the dysregulated area of their brain controls the variables in the video game or the video for example so let's say we're treating a child with attention deficit disorder and the child has very slow activity in the frontal parts of the brain which is what causes distractibility inattentiveness, inability to focus and we record that activity and whenever the brain spontaneously produces a faster rhythm which is associated with interest in the video game interest in the video, the video screen becomes very large as soon as the kid goes into the slower ADD activity the video screen shrinks down so we have a positive reward and a negative reward and of course the brain wants to keep the screen big so what it learns to do very very quickly even before the patient really understands what's going on is it starts to produce more of that faster activity and you know that if it keeps producing that faster activity neurons that fire together wire together that's the basis of neuroplasticity in the brain and so what you come up with at the end of a 30 or 40 minute session is a communication network in the brain that's much more efficiently wired for attention focus and control and as you reward this on a weekly basis over 8 to 10 sessions or so you can actually rewire the brain and I'm using air quotes here because we don't have actual physical evidence of that and yet we know that kids will function much better with focus and attention what we see is that this operant conditioning paradigm actually functions to help the person focus and to attend and to do better judgment better control, better impulse control over time and the conditioning paradigm utilizes the fact that this brain can produce activity that is consistent with focus and attention and we reward that every single time it happens with the neurofeedback training so the first thing we start with is a 30 minute free consult and during that consult we will do a clinical history we will document sometimes with an assessment questionnaire and always with a clinical interview what the person is suffering from what their complaints are what kinds of deficiencies they're noticing in personal work and social environments and then what we'll do is create a list of symptoms and we will make an appointment for a brain assessment we have two different kinds of assessments one of them is called a mini-Q Q stands for quantitative this is a quantitative EEG the mini-Q uses five electrodes on the surface of the scalp and it's a cognitive and it's a cognitive social behavioral assessment and we sit down with the patient and we discuss the possibilities of their symptoms matching what we found in terms of dysregulated areas of brain function when we get matches, those become targeted areas for treatment so for example, we may have a patient who's been suffering from depression has a history of depressive symptoms and not always, but very often we'll find dysregulated activity in the left frontal cortex when we see that and the patient says yeah, I've been depressed we can put an electrode there and we can reward a faster frequency which should be there so for example, when people are depressed they may have a frequency of like 8 to 12 cycles per second or slower in that region of the brain that region of the brain is responsible for executive function which usually demands a much higher frequency so we may reward a frequency of 15 to 19 or 19 to 25 cycles per second and the way we do that is when the person is engaged with the neurofeedback learning paradigm and let's say they're watching the movie again we will only let the movie screen be large when their brain spontaneously produces the faster rhythm when their brain produces the slower rhythm that has been subserving the depressive symptoms the screen shrinks down so during a 30 or 40 minute session you see the screen moving back and forth, back and forth and after just a few minutes the patient is able to keep it in the larger aspect ratio for longer periods of time so the brain learns very quickly to utilize that reward as a result of operant conditioning so these conferences cost money so that was honoring Stance Corporation who donated for the event and so like I said we don't endorse anyone's equipment but certainly can provide information about them being an option so we're going to ask if you have any questions to please come up here so that the video can be captured if you'll face that way or half way that'd be great but anybody who has any questions please come up one of the questions that I have is it seems like millennials especially young professional millennials don't like the idea of being offered neurofeedback and not knowing more definitively when we're going to start and when this is going to end in terms of they don't care a lot of them that I've been exposed to don't care so much about it being expensive they know it's expensive but they want to have an idea like is it $3,500 is it $4,000 is it $5,000 tell me because I need something more concrete I need a package that tells me where I'm going to go from here to here and I haven't figured out how to package that do y'all have any ideas about that practice I have some ideas from that experience but what I would then if we can draw from the client experience so I would ask then if my mind went to if you want to pay for something but my stereotype is millennials don't pay for something so I'm going to say if they wanted to go to a gym and develop strength or if they wanted to lose weight would they be able to know exactly how many times they had to go to the gym so try to think of analogies that apply to them that applies to their sensibility because really what they're asking for is something you can't exactly tell them but on the other hand you could couch that with well, we don't know exactly how many sessions and we don't know exactly how your brain's going to respond but why don't we start by saying let's look how you do after five sessions and after five sessions we'll know how your brain responds and then we can re-evaluate again so do you have any thoughts about that? I bet you're coming up to the microphone but that's probably what I would try to do with it basically what you've got is somebody asking you something that you can't give them but you're going to try your best to give them what they want and we opened this up to questions but if there are any thoughts if you're sitting there thinking we didn't talk about this or I have this experience that will be really good for other people to have this is just so more than a Q&A what's the call of conversation time if anybody has anything to add to what we've been doing I was doing my own training I had some life happen and decided I don't feel myself I sometimes will feel a bit of a buzzing here in my eyes around my eyes when I get activated and decided to do some training and I was having difficulty getting the numbers to improve and so I did tendly talked about doing hypnosis to help with your your feedback training there's been talks about coaching and whatnot and so I was doing my own training and I decided what could be getting in the way and what are some what do you all describe or how do you all define the word begrudge are there any ideas for what your definition for begrudge would be when so for example I describe it for myself as kind of a bit of a judgment or being irked about something so you kind of accept it intellectually but there could still be some energy around not being flexible so to cut to the chase on it what I did is I decided what am I begrudging I happen to be an amputee and this was an accident back from 94 I do really well in spite of it but I decided anything about it I just decided to let that begrudging go did it energetically or emotionally, psychologically decided I'm just gonna let it go what else am I begrudging maybe I'm begrudging a little bit the design the design of nature creation, God at some level decided to let that go I decided to see my siblings my parents and if there's any kind of begrudging that I might be holding on to somebody can cut you off on the road and they're just not doing it the way they're supposed to we can get impatient about how this seminar went and how things should have gone well we could decide to stay a little stuck with that or to just let it go long story short after I let go of all of my begrudgings my numbers improved dramatically that span of my doing that visualization if you will and I've been trying to incorporate it more in my life not just for that training I got so much out of it that I will check myself now am I begrudging that person am I being impatient about that or feel like I know that they should be doing it a certain way well I don't want to have that energy that you just think that you have the but you don't and so it's just so much relief from letting go of that and it improved my numbers and so I'm sticking to it so that's interesting my friend Carolyn Cohen who works with her husband she's an energy healer and she taught me a cleansing technique very much like that maybe we could just use that to end the conference if there aren't more questions the five minute techniques that we use at the end of the neurofeedback session so that we're sending off people feeling very refreshed and ready to take the world I think that's a great idea for me what I got from doing that exercise even if I didn't explain it all that well is that I lessened some tensions that I was holding on to that we're getting in the way and this is the importance to understand why therapy needs to work in conjunction with neurofeedback yes and why neurofeedback needs to be integrated hopefully this is like the ideal world setting that's neurofeedback it's part of the therapeutic process so you identify that because you know where it's going on you need to help the clients get more out of the neurofeedback on that same note I'm just curious whether it would be hard or y'all would say in that idea of kind of keeping yourself clean one of the things I've noticed over the many years and wondering if y'all have similar experiences that as the therapist in the room or the counselor in the room I can often tell that the clients can often get to the level that I am if I am nervous if I am uptight if I am angry I can swear I can see it in the numbers that the clients can see I can see the high beta I can see the heart rate go up and I'm just curious if y'all have seen the same thing oh yeah all the time all the time the clinicians that we work together is like if you have any personal issues anything like but I'm not talking to this patient doesn't matter just take the day off we won't help them that much because it's really transmitted and imitated and it affects the patient exactly the phrase I'm thinking we're talking about quantum physics and the transmission of energy we matter where I first noticed it was when I was first learning to do alpha theta neurofeedback and in that process you're basically doing eyes closed they're listening to some tone that crosses over when alpha or theta happens and I could tell that when I was in an intense state those clients didn't seem to get there and yet when I would take a deep breath and when I calmed down it was like all of a sudden the client would cross over you stayed in the room and I stayed in the room the whole time I believe in that process even in alpha theta I believe in watching the client being part of the client my tradition is I got taught what's called holding space and I believe even in alpha theta that's part of what I'm doing but it's this idea to do that and it's just been interested in me over the many years to experience that so it's that invitation that even with every client that comes in I have to clear myself or I have to be in some sense and if I'm not I have to be more myself because I just find it gets in that way if you don't I have a question about the study that you did with the children I didn't do it but I'll be happy to I'm sorry about that I kind of missed the beginning of that so you said optimally the time that the neurofeedback should be done for the children is 6 to 12 minutes do you have any idea when they figured that out and how they figured it out how was responding in the easy like if they were like conditioning the direction and suppose it was the other way they needed to stop the session because it was more likely these kids would have adverse reactions and there are many ways that they could figure it out but this is like neurophysiologically by itself it tells them stop I don't want to do this anymore or they were incredibly uncomfortable or or physical or neurophysiological or they can't let them know is that moment to stop yeah but it's it's hard to really get all the cues to stop to prevent over training thank you first of all millennials aren't that bad as someone who's really interested in a little bit newer what are the top criticisms against the use of biofeedback or neurofeedback people say lack of research or double blind studies whatever it may be then the second question is is there a particular form of therapy that has been researched to be most effective when using neurofeedback CBT or SFT or anything else thank you also just thank you to the volunteers and give it up for heart for this very good questions so I think the biggest criticism in other than lack of research and I'm going to say there isn't so much a lack of research but the research standard has been established predominantly by the pharmaceutical industry and they can do double blind studies whereas with neurofeedback that's hard to do there is NIH just funded a double blind study and the results of that was that presented at ISNI no not ready yet because Roger came to our conference early October and just dangled the carrot doesn't have the results and they need to present it to the funding agency first Dr. Roger Dubu is out of North Carolina and he's ahead PI for this in a combination with Ohio State and some other researchers on ADHD and it's a five year study in fact I think next week he's presenting he was telling us he's getting ready to present but they've been running it for this is the third year there's still two more years it'll actually be finished in 2020 and he'll probably take him another year to put all the data together but there is this multiple site double blind gold standard study that's finally being done and he can't give us any knowledge yet of what's going on other than he did say it is on track and he was I forget how many thousands of data points and pages he was saying he has the numbers and stuff so it's hopeful and it's exciting so it is coming at least in the era of ADHD in order for a drug to go to market it has to be 25% more effective than placebo that's not a commonly known statistic but the pharmaceutical companies have a lot a lot of money to promote their product with and we don't have a lot a lot of money to promote our product with so we're word of mouth in commercials and everything else that's going on so in my opinion it's not necessarily the lack of studies it's the lack of the ability to promote and the standard, the accepted standard although it's not the gold standard the accepted standard for studies is a double blind study and that's not very practical in the work that we do and I think our weakness that thanks to people here is this audience is that we don't or very few academic programs give you the training that you need to become a neurofeedback practitioner and until now in these new programs you need to figure out your way around and because these devices well not these but some devices they just train you for three days and you are ready to run a neurofeedback session this is what is a big criticism right you can train anybody to train neurofeedback just touching the computer but getting the it's a graduate course that is needed to be qualified and this is the effort of the BCIA to try to make sure that the providers have all the certification and the knowledge and I think this is a big criticism that we really didn't have the foundation like start weird start here instead of let's educate, let's learn let's have this educational pathway and then we will get there I think this is a big weakness that is trying to be fixed and another thing is and what else cost big makes a lot of resources I think that's probably the most important I don't know if somebody else have more ideas I ran a Baylor College of Medicine VA study randomized control trial with 100 veterans for treating chronic low back pain with hypnosis or biofeedback and it's published so there is at least one study comparing two different modalities that's great for your exercise I do want to mention that after I did that I call it the begrudging maybe I need to come up with a better word I don't know but I had a client come in and he said I need to do neurofeedback he was obviously agitated and I said okay you know we can but let's try this first and I did that exercise with him and he visualized different challenges for him business financial family and whatnot and by the time we were done with that visualization he said man I feel a lot better we did neurofeedback and it just it all just gelled so just to add to your physician about needing to work with the two so that you get the best result for the client did you say you wanted to do that was there an exercise you wanted to do no if we wanted to look at a report I usually spend an hour and a half going over a report with a patient developing looking at their complaints the data the analysis and recommendations so I don't think anybody wants to stay an hour and a half but maybe you know what we had a touch on was all here and I think looking a little ahead to the future we had had a nice graph of what do you do if you're starting and where is this field going to go I my personal opinion is that we have a lot of nice training programs in the United States and as Diana said what do we need the educational institutions to get on board with it so we've got the programs here Widener University South Dakota, Philadelphia does a biofeedback training program Carol Alstead in Connecticut does a biofeedback training program you have more take two of them yeah you guys are just well you're Texas that's what they say I am that's what I hear of their statebrook university but there are not many and so the training is coming from private organizations what's not as abundant in the United States as in Europe is the research and there is research happening in Europe and there's some good research happening there there's a university that's pounding off the research we've got some clinicians there that are really doing a lot of research independent from any type of equipment because equipment manufacturers do research but we're looking for independent researchers that's what you were looking for I think we also can learn a lot from Europe and it's being easier to do that so one of the things that's happening in Switzerland is they require biomarkers in order to be assessed as having had a disability the Swiss government their form of our social security disability system doesn't use reports from psychologists they use biomarkers so we need to have hard data in order to determine if somebody's got a mental disability and that's what the HBI group has been working on in conjunction with are those published somewhere? the published biomarkers the question is are those biomarkers published? Yuri Kropotov recently put out a book biomarkers in psychiatry it's not an easy read I've read it three times but there's a lot of data in there so what we find is that we've been talking about QEEGs all day intermittently QEEGs are variable they're variable according to the database they're variable according to the time of day which is why we collect the data between 9 and 4 but there's variability on how much sweet did you get the night before how much did you eat did you drink a cup of coffee before you came in even though I asked you not to have any caffeine and I sent you written instructions to do that so there's lots of variability the ERPs the evoked response potentials and they're accepted by the scientific community if I call up a physician and I say I have a QEEG they're like OK and if I call up and say I have biomarkers that indicate the evoked potentials are dysregulated they're like what? where? send me the report so if we want to cross over into other professions I guess the future will bear this out but my opinion to make someone I'm seeing in Europe is this is the path that's going to help us cross over and become more expected in the future I think the more the more we know the more we are learning we need to incorporate all this knowledge in what we can provide and have very objective measures and evaluate more successful what we're doing but yeah definitely I mean QEEG even though it's getting more accepted but still it has a lot of weaknesses but ERPs is generally more I mean we learn more and we have more research about ERPs so it's more accepted and just for you as a clinician just to have more information is very valuable and because the medical community is more aware of the ERPs they will accept this year and they will understand it better the research on EEG if you look over the years kind of goes like this in terms of increasing research and the research on ERPs goes like this there are many many many articles published articles on it what is Switzerland using to measure the ERPs so they're collecting the EEG and there's a so there's a visual continuous performance task as part of the EEG so their standard is 10 minutes size open 10 minutes size closed and then 20 minutes with the task and in the task you're looking at a visual continuous performance task it's actually called a go-no-go task I don't have a handy picture of it but on the picture an image flashes and the image is an animal if it's followed by another animal the same animal that's a go condition that's press the button then there's an animal followed by a non-animal that's no-go and a non-animal followed by anything is ignore so what does the brain do that I got to get ready I might have to press the button and then another animal go but what has to happen in order for that to occur the visual image has to get presented to the brain so that you both potentials measure how does that image get received by the brain and then the auditory sound also well I didn't mention the auditory but there's an auditory sound embedded in there occasionally so we measure how does the brain receive the auditory input and then how does the left side activate meaning how do I compare what I have seen to other things that I've seen it's got four legs, it's got a tail it's got four- oh that's an animal it's a bear what's my emotional response to that this is all happening on an unconscious level of course and now that I've done that analysis I have to hold on to my instruction set is that something I press the button for should I not press the button for and how did I do so we finish up with assessment that process happens three times a second so it goes on and on and on but that's a very stable process people will say to me well you know what I I didn't eat a lot or something I didn't feel so good that day and the thing was my vitamin D down because I didn't feel so good your blood is pretty stable we can measure your blood and we can see we can measure your ERPs across time and they're pretty stable so that's the process of how they're measured so we have a lot of information because second continuous performance test we can measure reaction time errors and emissions and all the neurophysiological data with the ERPs and each of the waves and the latency and the amplitude and each of them have a meaning depending of where is the region of the brain that is processing the sensory information so it's really very rich and all the information you can get needs more consistent and this is why they are using it more for biomarkers now you can't train ERPs directly you train ERPs through the EEG and then the ERPs will change the ERPs value is that they are very stable and they're very patient identify with them if you can see that their visual processing is slow that's going to probably relate to they have reading difficulties my daughter is visual processing my daughter is really I'm very proud of her but she does this funny thing you'll talk to her and she'll say actually a silly comment back the silly comment might be like I'd say a silly comment black like no Jenna a silly comment back yeah I know well we did her ERPs and her auditory processing is delayed and so as we explained this to her she actually said I know that and I know by the time I say it by the time I say black I've heard it properly and I know it was back but I don't want to waste the time to correct what I'm saying I'd rather you have to think through it she knew that whole process so that's a really nice so it's not a problem she's made it through life and people think she says this funny thing but if you have a visual problem that's a little bit different yeah we have a question from online we want to involve our online community oh yeah and so it's a little off topic but Diana Valdez from Fort Worth is asking I'm interested into two excellent presenters I'm wondering if they are trained and or use clinical hypnosis in combination with bio neurofeedback with their clients I'm an ASH certified American Society of Clinical Hypnosis my early years were actually in hypnosis I was very active in the Philadelphia Hypnosis Society so while I have not maintained my active status in ASH I still am very familiar with hypnosis and I think it's an important tool that I have that I can use in working with clients so even just pacing with their breathing and making suggestions and I do from time to time use hypnosis thank you Diana anybody else have any more questions what would you like to do did you say that you wanted to offer you're very gracious in asking if anybody was interested in you sharing how you present an assessment report was that correct and what I heard you say I'd be glad to do that can I keep anything it's Saturday did you just scroll down to do a good question the energy I'd be glad to do that too so we could even split up if we wanted to or if people want to do both we're here so I don't need till 7 o'clock tomorrow morning one thing that popped into my mind is you mentioned that you have a list you could email it to us so we could distribute it fast about some habits or practices that you ask of your clients and patients that are doing a neurofeedback and biofeedback so that they are more assured of having a positive response I'll be glad to do that so I guess it's up to you I think we're both willing to go through a report we could slam through that in 15 minutes I can do a cleanse thing what do you want go ahead, cleanse oh that was pretty serious report can you send us a report so we can look at it yeah I can do that I'll send you a report without me okay I'll do that with template because that's a whole other thing I'll send it to Art I think that'll be easier right alright okay so any final questions or we'll do a cleansing he has them or should have them somebody's got them and there's a couple of extra things in there there's a where they draw and talk I don't know what they call those on a slide presentation there's a couple of those in there that I got from HeartMath I think there's a couple of forms that I used that I put in there glad to share keeping in mind with sorry I'm moving but keeping in mind with we need to be in the right space to do this I need to feel relaxed while I do it as well alright we're going to finish our day here anyway slide forward so I can see everybody and let's begin eyes open or eyes closed it doesn't matter and let your feet rest on the floor and just let yourself begin to notice how the floor supports you how your feet feel in your shoes hold your chair hold your weight and you can let yourself sink into it without judging just noticing let yourself notice these and the rhythm of your breathing whatever you're doing is fine is your breathing deep is it shallow it doesn't matter let yourself notice it let yourself take one or two more breath and while you do that through imagination place a trash can next to you and let yourself notice whether you're holding on to worry that aren't needed and let them be placed in the trash can right now you don't need any worries there's nothing you can do as you sit here you can let them go and are there fear fears from the past fears better currents you can place them in the trash are you holding on to worries that don't even belong to you worries of loved ones maybe something that you picked up from a patient even something that you've been holding on to from somebody that you don't know you can place those worries in the trash apprehension are there apprehensions about the future that can be released and placed in the trash grudges that aren't needed that don't do serve any purpose can be placed in the trash are there any obstacles that you might not even be aware of that have held on that are not needed you don't need to define them you can place them in the trash let yourself become aware of your breathing again without judging just becoming aware and take another moment and just notice if there are any residual thoughts feelings that you'd like to release and place in the trash go ahead and do that and there may be other things that you're holding on to that you're not sure it should be released but you can release them and rely upon your brain and body's ability to find its own homeostasis so let those things go place them in the trash and when you feel done close the lid knowing that you'll leave the trash behind here and take a moment and let yourself enjoy any openness that you might feel inside if that doesn't make sense to you that's okay just take a moment and follow your breathing whatever pace it's at and after one more breath go ahead and open your eyes with a sense of feeling refreshed and ready to enjoy the rest of what lies ahead of you so some people yawning that was about four minutes so it doesn't take that long and if anybody wants to make any comments we can and if you feel like you just want to leave thank you very much for coming I think you all had an enjoyable time I appreciate you being here and appreciate having us thank you very much we feel very fortunate to have had you present to us thank you again and this concludes our conference in terms of audience and clinicians that are visiting for CEUs we are going to stay behind to have membership meeting and so we're going to try to make that brief because it's been a long day so if you want to stay behind to participate in our membership meeting we'll start that shortly thank you