Dr. Andrew Hill on Innovative Neurofeedback Techniques to Heal the Brain

Dr. Mark Leeds [00:00] Dr. Andrew Hill, welcome to the podcast. Thank you. So like we were just talking about it, I’m very interested to hear about what you’re working on with neurofeedback. So yeah, please tell us more about what neurofeedback and brain mapping, what these things are.

Andrew Hill, PhD [00:18] Sure. So brain training or neurofeedback is a form of biofeedback. And we essentially measure the brain in real time. And when the brain briefly shifts in the right direction, we applaud that with auditory and visual feedback. So it’s a form of operant conditioning where you sort of watch what’s happening in terms of like behavior. In this case, behavior is involuntary. It’s brain waves. And you can sort of create this change in the brain over time progressively using neurofeedback. We start with this thing called brain mapping or quantitative EEG, which is an assessment of the resting patterns that one person’s brain makes compared to an average population. And it’s a little hard to interpret one person’s brain because people are kind of weird. So we’re using this population comparison, but the goal is not to say, you know, why aren’t you average? It’s to look for things that are sticking out that might help you understand resources. And the stuff we can see in a brain map would include things like attention, anxiety flavors, sleep architecture, or the consequences for not having good sleep more accurately, sensory and social irritability, and things like brain fog and speed of processing. So big gross resources are what we can pick up in a brain map. We also do performance testing. So I always combine a QEEG or the brain recording with continuous performance testing or a go no go style attention test. And both of these things, both the brain and the performance are compared to age match samples. So we see how weird you are compared to folks your age. And out of that, we often develop sort of workout plans to go after the brainwaves and people train their brain for about three or four times a week for half an hour at a time. And you start to feel it in about three or four sessions. And then you get an after effect each time. And you can sort of, think of neurofeedback, like personal training for the brain, where you have this, you know, these goals you’re going after you exercise the brain for a little bit, and then you have an after effect for the next day. And you can kind of grade your workout based on how it landed and how you’re asleep and stress and things are moving. So,

Dr. Mark Leeds [02:29] Well, it’s really interesting. Years ago, I was a subject and I got to try out some kind of a neurofeedback system. I remember this was probably going back 30 years and they hooked us all up to EEG leads on our heads and we were hooked up to like a PC with some software. And I think there was audio feedback. I think that our goal was to get the tone that we heard in the headphones to a certain, or get it to go down in pitch or something like that. And at one point, there was actually a video game they let us play around with where you get these balloons to go into a bucket or an area in the middle of the screen. You actually control the video game with your brain. So you just look at it and focus, and you could actually control what’s on the screen.

Andrew Hill, PhD [03:15] Interesting. Most neurofeedback is actually involuntary. What you’re describing sounds like something called slow cortical potential, where you can concentrate and change things in real time. The vast majority of neurofeedback is involuntary because you can’t feel your brainwaves and you can’t really control them all that voluntarily. In fact, neurofeedback was discovered pushing 60 years, like 57 years ago now, on cats. And cats are really bad instruction followers, right? So it’s sort of this involuntary training. And I’ve done tons of work on people that are nonverbal, people that have no language, people that have impaired cognition. And it works regardless of what’s going on with your brain to some extent. It’s not really a participatory process, but you get to sort of pick goals and then grade the after effects. So that’s sort of the voluntary piece from our perspective is deciding what you’re working on and moving through and making some change. You know, I didn’t describe what it actually is. Maybe I should back up and describe the technique because people often are thinking it’s this sort of, you know, black art where we’re manipulating brains. It’s not that complicated. We’re just tapping into normal learning processes in the brain. So let me give you an example if I could. Can I give you an example? It’s either in the, I don’t know, anxiety or attention or maybe craving area. What would be? Yeah, craving. Craving would be good. So if you drink alcohol routinely, you know, several times a week, after a few weeks or months of that, the brain starts to make more glutamate because the GABA released by the alcohol is so powerful, it’s so sedating that the brain is concerned about the balance of GABA to glutamate. It starts to raise the glutamate. And if you then withdraw alcohol, you know, months and years later, someone’s left very shaky, very unable to downregulate, to soothe internally. And this tends to produce, even after a few months of chronic drinking, this tends to produce a chronic over-arousal state where somebody is really anxious. They tend to crave alcohol because it’s the only thing that reduces the activation tone. And it really impairs sleep onset, sleep quality, sleep depth, all kinds of things. So very classic phenomena of using things like alcohol for some support, and then they erode your regulatory stability until you’re more anxious, more shaky, more activated than before, which, of course, drives more craving. So I see a lot of that. Historically, I’ve seen a lot of people who get into this condition. And you can look at their brain, and the brain is running lots and lots and lots of beta waves. And the beta waves are all stuck together. They’re hypercoherent. They’re letting go. And generally these people aren’t able to get into deep sleep very well and the really hard part is often transitioning in and out of sleep. Getting into sleep initially is really tough. So we do a combination of work with people like this. We do what’s called SMR training or low beta training and we also do something called alpha theta. These are different techniques but SMR is used to fall asleep and sit still and also resist impulsivity. So typically when working with alcohol cravings, you want to think about the executive function aspects and maybe the anxiety aspects and work on those and then work on rebuilding the brain’s hyperarousal that it can’t calm down again. So we would start with executive function and sleep phenomena called again SMR, sensory motor rhythm. If you’ve seen a cat in the windowsill watching birds, you’ve seen SMR. It’s that liquid body and laser-like focus, completely still physically but mentally on, literally the opposite of ADHD. Literally. But SMR is also used to resist seizures, to fall asleep and stay asleep, to sit still, to resist impulses. So executive function is a big piece in dysregulated relationships with substances. You often want to bring up people’s executive function sort of tone. And that’s again, a largely a beta phenomena and it lives on the strip of tissue that runs ear to ear. The precentral gyrus is involved with voluntary behavior. And if you look at somebody who is having difficulty with decision-making or executive function, be it from chronic alcohol use or a concussion or ADHD or chronic sleep issues, lots of reasons. But what you’ll see is the person’s generally making too much of brain waves called theta. They’re disinhibited and not enough beta or they have control over the beta, the low beta. And in case of alcohol, a lot of very fast frequency betas are instead dominating. And so what you want to do is exercise someone’s brain to bring up the frequencies, this low beta that lets them sit still, fall asleep, resist alcohol, et cetera. And most of that lives in an area of the brain sort of on the right-hand side. And it’s a supervisor of what we’re doing. It knows if we’re on the right road. It’s reading the map. It’s navigating. It’s sort of telling the driver, hey, wait a minute, what are you doing? And so it pulls back on behavior that’s more automatic or impulsive, which is a part of craving. So we generally want to train up, exercise up this low beta. And so you stick some ear clips on and put a wire on the scalp on that one spot and set the computer up to measure that low beta wave amount, the amount one person makes moment to moment, and also measure the amount of theta, which is that disinhibited, more automatic brainwave. And as you watch the brain, as the computer watches the brain, the brain’s going to shift a little bit moment to moment. And whenever it shifts briefly in the right direction, the theta goes down, the beta goes up, computer sees that and starts to applaud the brain. And the brain’s like, oh, hey, stuff’s happening. Kind of like stuff. Stuff’s cool. And then it happens to move in the wrong direction. That theta might go up again. The brain stops getting its feedback. The game slows down or stops. The brain says, hey, where’s my information? That’s kind of annoying. Nothing’s happening. Then it happens to move again in the right direction and the applause continues. The big trick being we move the goalposts every few seconds we adjust. So we’re only applauding the movement in the proper direction. And again, it’s mostly involuntary. You can’t feel your brainwaves. You can’t really control them. But somewhere around two or three sessions in, the brain says, oh, oh, oh, you want some beta. And it gives you a nice big surge of beta for a few hours. And you walk around after the session going, wait a minute, might be feeling a little different. Huh. And then it wears off. And you’re like, I don’t know. Was I imagining that? That was kind of strange, kind of subtle, but I didn’t notice something. And the next time you train, it happens again. So then you’re off to the races. You have this iterative process of like gently pushing on your brain and watching what happens afterwards. So you can iterate through making change. And this low beta tone, this SMR, again, helps with things like executive function and sleep architecture. But then with someone who’s dealing with a lot of alcohol, there’s that decades of learning around the inability to soothe and downregulate, the inability sometimes to feel comfortable with the internal environment. And of course, we have the sleep stuff. So we would typically in alcohol use a technique called alpha theta on top of smr training so alpha theta brings people to the edge of sleep that hypnagogic access place where all the ideas and creativity starts bubbling up but you’re half asleep so you forget the awesome idea the next day you can bring people to that state reliably using alpha theta neurofeedback where you have them close their eyes and reward the brain waves that surge in this sort of non-linear deep deep relaxation state and in that state, you’re making huge amounts of T cells, growth hormone, relaxing brain waves, etc. And if you do even 20 sessions of alpha theta, the cravings go away for people. You can see multiple standard deviations of change in a bell curve in resting brains going from like beta waves that are three, four standard deviations off the chart to typical. And somewhere around four to six weeks in, people that are shaky and nervous and can’t relax without major meds can calm down at will and fall asleep at will. I remember the first time I saw this, I was working in an addiction center in Beverly Hills and we had clients with real significant alcohol difficulties. And this was a place that doesn’t exist anymore, but this was a company that had both an abstinence track and a moderation track, which is a really hard thing to work on sometimes in alcohol. So I was seeing lots of people at different stages of dysregulated relationships, especially with alcohol. And one gentleman had been drinking for 25 years. He would go to the beach in Santa Monica. He was a writer. So he would sit down, open his laptop and drink a bottle of wine while he wrote a book or his articles. And then he would go home and be a little activated. So he’d drink more wine and Ativan and Ambien to fall asleep. And he would wake up two hours later, wandering around West Hollywood, all disoriented in his tighty whities and end up in jail half the time because he was, you know, on the Ambien disoriented and then, you know, big scary man who was seeming confused. And this kept happening and he would go from rehab to rehab. He would have cravings, nothing would work. And he was in a rehab, with being medically supervised for a detox. And he got through six or eight weeks of detox and he said, yeah, I don’t think I’m gonna be able to not drink. There’s a brain center over there across town. Could you guys drive me from the hospital to those guys. I think I might be able to help. And he walked into our office cold and we worked on him for a couple of months. About six weeks in, I walked into our office and he’s asleep on the couch. I said, oh, is he here for another visit? I thought he already came in three times this week. And the front desk person said, yeah. He called up this morning to figure out when you were coming in. He came in half an hour early and went to sleep. He discovered he could fall asleep at will. I wanted to prove it to you. So he’s asleep because he wanted to prove he could turn his mind off and fall asleep at will. All right, let him sleep. So it was such a huge thing for this guy. He had to like rush in and take a nap to prove to us that this was a thing he could now do. And he was, you know, about 67 at the time and it had been about 25 years since he’d gotten a good night’s sleep. And month and a half in all that beta dropped away in the brain. He could turn his mind off at will. He could fall asleep. He wasn’t craving alcohol. He wasn’t well regulated yet the quality of sleep wasn’t ideal yet you know all that damage all that stress wasn’t yet rebuilt in six or eight weeks but it kept going and he kept making more and more change and was able to remain abstinent he walked in trying to think about moderation you know because alcohol had been part of his life for decades but he ended up going to the abstinence track in that company and I think at the one year mark I saw him and he was had remained sober which was the first time in three decades, had been sober for more than a few months. So it can really re-regulate this acquired problem. I consider alcohol abuse an acquired problem in the brain. It can acquire damage. It starts with learning, driven by anxiety, driven by impulsivity, driven by difficult emotions, maybe trauma, maybe sleep issues. But that process creates change in the brain over time. And then you end up with a brain that is sort of learned into a dysregulated state. It’s really hard to back out of that without some assistance. The brain doesn’t like to recover from that hyper arousal state really easily. So I see these brain patterns in these folks that drink routinely, even after they’ve quit drinking for 10 or 15 years, you still see that same shaky active beta if they drank daily. Now, binge drinkers don’t show this pattern. So college students, 95% of them will binge drink sooner or later, and 95% of them become drinkers without a problem. They transition out of that problematic drinking. But if you drink daily for even a few months, that tends to change the brain really aggressively. And it’s a really hard thing for the brain to rebound from just on time and healing. And so getting some good shifts like neurofeedback in play, as well as other biohacks that might support you, saunas, ice baths, maybe naltrexone or some other opioid blockers to reduce the reward nature of alcohol. These are all useful strategies and I’m not here to tell any individual listening what they should do, but I am here to tell you that you should do something. You should take control over your brain. If you aren’t happy with how you’re behaving or how your brain seems to be driving the bus, you can learn about it and you can make these changes even when it’s really extreme, like decades of drinking leaving you super shaky and dysregulated. The brain is really changeable. You know, shift happens. You can typically back out a lot of these difficulties relatively quickly once you know how to apply pressure.

Dr. Mark Leeds [15:47] Yeah. Yeah, that’s, when you’re talking about alcohol, another situation which is related but very different is people who are dependent on benzodiazepines. Like you said, like Xanax, Ativan, Valium, Klonopin, those are the main ones, and there’s a lot of other ones. And the majority of people on benzodiazepines are not addicted to them. They’re physically dependent, and they may be treated like they’re addicted. They may get sent to rehab and detox way too quickly, and they can end up with long-term, probably similar to what you’re saying with alcohol, where a person 15 years out can still have symptoms. A person who comes off of benzodiazepines too quickly can be left with long-term protracted withdrawal. And even people going through a very gradual tapering process. Like I work with patients who are tapering. And even when they’re tapering at their own comfortable rate and taking just very tiny little reductions, they still have adjustments to make and go through withdrawal. And, you know, this sounds like it’s I think it’s similar, you know, with the issue with glutamate and GABA and that balance and, you know, whatever other recovery processes are happening in the brain, you know, that this might be something beneficial. And another thing that’s interesting is that people going through benzo withdrawal often cannot tolerate any kind of medication. So when you go to a doctor, the, you know, immediately the response from a doctor is like, let’s give you medication. Let’s try, you know, this or that and see if that helps. And they can have horrible reactions to even a small dose of something that would be harmless to someone else. And so, yeah, yeah. Yeah. So what do you, what do you think about helping people with benzo withdrawal and long-term protracted withdrawal?

Andrew Hill, PhD [17:37] Yeah, so we have some good tools. Neurofeedback can generally help the system re-regulate. I work with a lot of folks who withdraw from benzos. And you can see in many people, the biggest issue is managing the things that flare up as they withdraw. So the pain, the anxiety, the sleep disruptions, these things seem to be pretty common. They’re actually really tractable. You can work on pain directly if you have breakthrough pain, let’s say, or breakthrough anxiety as you withdraw. What I will say about neurofeedback and benzos, if you’re on high levels of these things, it gets in the way of neurofeedback. It actually can impair learning. So it’s hard to do brain training on somebody who’s on high doses of Xanax and other benzos. You have to sort of be able to have some clearance time, only have them once a day or something before the neurofeedback is going to work. If you’re on huge levels, I’ve worked with thousands of people, something like eight or 10,000 people doing neurofeedback. And the only people in like three or four people total that I’ve not seen their brains move. In two cases, I discovered they were on very large doses of methadone or heroin impacting the learning essentially. And the other two cases, it was super high doses of benzos. So benzos can really impair learning. And what’s interesting is the benzo drug class in general makes the brain look anxious. If you have benzos in your system, you have these little spindles of beta waves, which are really similar to the thing someone feels when they’re feeling that friction of anxiety, that’s a little beta spindle. You see it as a fast frequency beta wave, but that’s what Xanax produces as a side effect in the brain, these little rustic spindles. So it’s almost like your brain is producing anxiety that you can’t feel while Xanax is on board. So you can train straight through many, many drugs, but if you’re on high doses of those drugs, it can actually be really hard to get the brain to start moving.

Dr. Mark Leeds [19:36] But a person who’s on a low dose relatively or even off of it for a long period of time. A managed dose.

Andrew Hill, PhD [19:42] Yeah. Yeah. Either withdrawing or on a dose. I mean, I take your point about addiction versus dependence, right? Addiction requires both tolerance and dependence. And so you don’t have probably in this population described who’s using it routinely, you don’t have the same tolerance, you don’t have the same need to ramp up the dose, even if you are dependent at that point, sort of, you know, physiologically accommodating it. These are things that will change if, you know, you can really wipe away the tolerance, actually, for many drugs. It’s not quite that reliable for benzos. It’s super reliable for stimulants. Someone’s abusing stimulants and you have, be it prescription or, you know, illegal stimulants. If you do neurofeedback, you wipe away the tolerance to stimulants really quickly and also to cannabis. Now the stimulants and cannabis are not abused the same way. They don’t cause the same difficulties generally that alcohol and other drugs of abuse can cause, but they’re also lifestyle drugs that many of us take, you know, cannabis, just alcohol. And you will get a potentiation. So if you’re abusing your Adderall or you’re on some sort of stimulants that you’re getting into a little too deeply and you start adding neurofeedback, the drugs start working two, three, four, five times stronger after a few weeks. And as you may know, moderation requires low tolerance. So if you have super high tolerance, it’s really hard to moderate your substances. But if you have really, really low tolerance, it’s hard not to moderate. Right. So neurofeedback is a tool where you can wipe away the acquired tolerance that you get. And it really helps in a re-regulation, so to speak, with substances. It helps people get control over them again because they don’t have to reach for the highest amount or the continued dosing. They can have a bit of a different relationship with it over time.

Dr. Mark Leeds [21:31] Yeah. And that’s a good point with stimulants. With a lot of these other things we’ve discussed, There’s medication-assisted treatment. For example, opioids, we have Suboxone. And Suboxone or buprenorphine has its own issues of long-term dependence and getting off of it. So this sounds like a good solution to help people through that tapering process of getting off of buprenorphine or Suboxone. But then when it comes to the stimulants like cocaine, methamphetamine, or even things like Adderall, There’s not really any kind of medical treatment or any good medical treatment to help people get off of them and not go back to them or be able to get through that difficult withdrawal period.

Andrew Hill, PhD [22:12] Well, of course, you have with drugs of abuse. You know, we choose the drugs. We double down on the drugs that serve some particular need, like not everyone’s into the same drugs. And with the stimulant class, if you’re abusing them, it’s usually because you’re impulsive and or have difficulty with managing executive function. It starts off that way often. Anyways. It’s all very rewarding. The dopamine is very rewarding. But if you give somebody a course of neurofeedback, again, you walk back all that tolerance. So you create different relationships with stimulants over time. And you also eliminate the reason people take stimulants, at least prescription stimulants. So impulsivity, inattentiveness, trouble with speed of processing, trouble with waking up from sleep, these are things that neurofeedback usually makes permanent changes in a few months. So on like a bell curve of executive function, you can usually get a full standard deviation every other month with neurofeedback, every 25 sessions roughly. And if you take somebody who’s really impulsive and really anxious and you give them control over their impulsivity thoroughly and drop the anxiety back to a natural response, a lot of drug abuse just drops away because people don’t want to be dysregulated. They’re serving needs. So if you pull the need, if someone has no trouble falling asleep, they’re not super anxious and they’re not impulsive, behavior often regulates itself because people want to thrive. They want to drive that sports car on the road, not crash through the forest. So once they have a little more control, you generally see people’s behavior shifting because their relationship with substances is allowed to shift as their brain changes.

Dr. Mark Leeds [23:53] Yeah and like you described this is way more advanced than this thing that I tried 30 years ago it sounds like you’ve you’ve taken out maybe the it sounds like you do a lot more like you’re actually mapping like where stuff’s happening in the individual person’s brain and then the subject is not having to sit there and focus and make something happen you know they can just sit back and is it that they look at a screen and see things happening on a screen

Andrew Hill, PhD [24:18] Yeah yeah we’ll throw up like a simple game a pac-man or some picture grid you know puzzle pieces that will fill in and the computer watches the brain moment to moment when the brain briefly shifts or stays shifting in the right direction the game play happens a little puzzle pieces filling in or a car driving or something and then the brain moves in the wrong direction and the game slows down or stops so the game’s like making audio and motion at you know stimulus the brain’s like oh stuff and then it slows down and stops and then it continues again so the whole time you’re doing neurofeedback in a classic sense these days, you’re watching games that are stopping and starting. But the brain’s hearing, good job brain, good job brain, good job brain, nope. Good job, good job, good job, nope, again and again. And so it ends up being more about, I don’t mind this game versus I’m trying to do something. And people often sit there and they try to focus, they try to concentrate, it doesn’t really matter. And then a few sessions in, they stop trying. And that’s about when things start to happen is the brain goes, oh, you want some brain waves to do this and you get like a day or so of shift after a handful of sessions and you start feeling the after effects and it’s really empowering to go well wait a minute I decided to do something and then I felt different in that way oh I mean even showing somebody with you know strong dysregulated anxiety I can show you that anxiety in a brain map it’s visible I can show you your perseveration rumination hyper vigilance busy mind social irritability sensory reintegration, it all just jumps out on a QEEG. When I show you your suffering, it’s not instantly different. It hasn’t solved problems right away. But the moment you understand how it’s working in your brain, it’s a whole lot harder to be overwhelmed by it, shamed by it, to feel guilty about this thing that’s happening. And knowing how your brain works can start to give you control over making changes. So I encourage everyone, if you’re suffering, don’t just suffer in ignorance. Get into your brain. Learn how it works. And it will often give you some strategies to take control. I mean, neurofeedback is a very high tech and very involved process. Takes a few months. You can make huge changes and it’s really valuable, I think. But there’s all kinds of things you can do once you know how your brain works. If your speed of processing is off, you hack your sleep. If your anxiety is off, maybe do some biofeedback, HRV or something, meditation. So once you know how all these regulatory resources are operating, you can make better choices to gradually tune the system in the direction you want versus potentially just reaching for the palliative substance, which is reducing some drive of suffering or frustration or something. But it’s not necessarily shaping the machine in the direction that you want to shape it. So if you’re already reaching for drugs and alcohol, you’re already adulterating the system, well, why not do something to change it in a different direction? Take some control. If you don’t mind mucking about with your head, maybe try to work on the anxiety and the sleep onset and things like that, instead of just feeling briefly dull and euphoric.

Dr. Mark Leeds [27:15] Yeah. I wanted to ask you about a few things that are maybe either somewhat related. Just, you know, we’ll go quickly through these few things. One thing that what you’re talking about reminds me of a little bit, but I know it’s maybe it’s completely without the feedback part, which is, I think, a major part of it, is binaural beats, you know, where you listen to these recordings that entrain your brain into like, you know, and they talk about alpha, beta, theta, delta, you know, and I do like listening to them, like the delta recordings and they’ll put me to sleep and things like that. But can that, I mean, clearly that’s not doing anything close to what you’re doing because you don’t have the feedback part of it at all, you know, that you’re not controlling.

Andrew Hill, PhD [28:00] It’s not actually doing what it says in the tin. Binaural beats do not create the brain waves they say that they create. The human brain does not appear to have a frequency following effect when you play two different frequencies in each ear and the brain picks up the difference. That is demonstrated in some animals. It’s never been demonstrated in humans. And lots of research looks for it and does not find it. Binaural beats is another form of meditation. You might as well listen to your favorite music. The beats themselves do not matter. Binaural beats, binaural beats, it’s all bunk. It’s all sham. Yeah so if you enjoy a particular Hemi-Sync or whatever audio great you know you’re doing an audio meditation and that may have benefits but I would not spend lots of money on binaural beats software or audio tracks because they don’t do anything and I’ve done a lot of research in this both in labs as well as in the literature it’s a non-starter binaural beats are they’re not quite as bad but you know there’s certain things in the health and wellness space you should run from when you hear these words one of the words is quantum someone’s using the word quantum in a health and wellness contacts, they’re a charlatan unless you’re sitting inside of an MRI machine, basically. So, binaural beats are in that same landscape. The vast majority is just bad marketing, bad science, and there’s not much there.

Dr. Mark Leeds [29:13] Funny you say that about, because I’ve found that some of the recordings that I like, they work just as well for me if I play them on the open air over a speaker. So, I’d agree with that it’s more of a meditative.

Andrew Hill, PhD [29:25] It’s meditation, yeah. It’s anchoring your attention, which is useful and powerful, but it’s not a magical secret alpha track that you’ve gotten access to that’s going to fix you.

Dr. Mark Leeds [29:34] Okay. And that would cover also the mind machines, which are similar. We have headphones and flashing glasses.

Andrew Hill, PhD [29:42] AVE, audiovisual entrainment, the light may do something. It’s kind of a weak effect. I think the old school AVEs don’t do an awful lot. A lot of them combine auditory and visual entrainment, but light flashing, light stim does something. We’re not quite sure. I think the way it can be used is to break up stuck patterns in the brain sometimes, but it’s not a very strong effect. And entrainment, flashing lights and things creates some effect in the brain that goes away instantly when you stop the entrainment and there’s no after effect. So it might be doing something, a driving effect with photic stim, you know, light stim. And then there’s good research emerging these days that you can do direct stimulation onto brain tissue using light, using red light, different frequencies of light will sort of supercharge the mitochondria’s electron transport chain and feed it more strongly so it can whip around and make more ATP. So I do think that some of these techniques that stimulate the brain are useful, but the ones that have been around for 50 years are not, the ones that are coming out now that are, you know, pulsed red light or specific frequencies of light that go into the scalp and feed the mitochondria. I think those are useful, but unfortunately things like binaural beats and most of the auditory visual entrainment devices, they’re sort of tapping into a consumer need or interest in a mystery or a magic and they don’t do much and they kind of charge, you know, a few hundred to a few thousand dollars for that mystery. I’d rather you work with an individual who knows what they’re doing and guide you through some somewhat complicated stuff because there’s a handful of things in the biohacker or health and wellness world that are just nonsense utter nonsense and they’re getting lots of money just to rattle off a few sacred cows that I would like to kill here blue blockers mostly meaningless blue blocking light doesn’t do much the only light that matters for blue is first thing in the morning so don’t wear blue blocker glasses it’s kind of nonsense and things like non-native EMF. Somebody is getting ready to type in the comments right now angrily that I said that, but non-native EMF does not do anything to the human brain as far as we can tell. It takes an extreme amount of energy to get through the skull, the bone, the fat layers. It’s really, really hard to get energy in and out of the brain. I spend all the decades, you know, 30 plus years trying to get electricity through that threshold. It’s very, very, very hard. You can even do like ECT, you know, stimulation, electric convulsive therapy on a skull and almost all electricity goes around it and not through it. It’s really hard to get in and out of those layers. It’s a lot of insulation. So yeah, don’t, don’t be too concerned about trying to find the absolute magical best biohack. Just start learning how your system works and make small progressive changes.

Dr. Mark Leeds [32:32] Yeah. And I think you might be alluding to this a little bit, but another term people hear and could potentially spend a lot of money on different devices and techniques, polyvagal theory. What do you think of that? The vagus nerve in three branches and each do different things.

Andrew Hill, PhD [32:52] Yeah, I think it’s a valid theory. I think it’s a bit more complicated, perhaps, than it needs to be for the individual. You can really just think about the vagus nerve being the integrator between the gut, the heart, and the brain as it goes up, and the brain, the heart, and the gut as it goes down, and the heart’s beat-to-beat timing, the heart rate variability is the integrator of the descending information and the ascending information. So you really can think about just the heartbeat, the heart rate variability. You know, what happens in the vagus doesn’t stay in the vagus, ironically. And you have this ability to train the heartbeat using biofeedback. So that’s a voluntary process. You clip an ear clip on and you listen to your heartbeat mathematically lining up with your breathing called coherence. HeartMath makes a good device for this. And that is huge. Heart rate variability is a valid thing. It trains the peripheral nervous system. And by doing that, you can train the brain directly. So it’s often a really useful technique either by itself or adjunctively with other biofeedback and other therapies so I’m a huge fan of hrv biofeedback it’s definitely legit

Dr. Mark Leeds [33:57] Okay yeah and there’s there’s a oh what is it what’s it called I think it’s called safe safe and sound protocol it’s a sound thing that was actually developed by by the that guy Dr. Stephen Porges, who I think is the one who described polyvagal theory, and where you listen over time under the care of a therapist to, I think it’s five hours of music programs where certain frequencies have been filtered out and they gradually reintroduce these frequencies. And it has some effect on, I think, on a bone in the middle ear or something like that. And it helps with anxiety and anxiety conditions and things like that.

Andrew Hill, PhD [34:37] Yeah, I’m somewhat familiar with it. I’m not deeply familiar. I don’t understand the theory behind it but I do know that all the safe and sound practitioners that we share clients with tell their clients not to do neurofeedback because they think safe and sound is too powerful and nothing else should be combined with it I’m of the impression you should always take care of your brain and do things that support you but there’s this sort of like my impression is there’s this restrictive like don’t do anything else if you’re doing safe and sound coming from those practitioners and they think their stuff is extra special in a certain way. So that’s my, you know, from the outside world perspective, I’ve, I’ve, I’ve done some of those techniques myself. I’ve done some of the bone conduction listening studies, looking at my own auditory function by some of those same practitioners, but I don’t really understand why they’re, using that technique and think that it needs to be used in isolation. So that’s my primary impression is not understanding that clinical end of the field, basically.

Dr. Mark Leeds [35:32] Okay. And then just finally, some people go in for, what’s it called? The thing, it’s not ECT, but where they use… TMS? That’s it, TMS. Now, I would think TMS may or may not be helpful. I’ve heard good and bad about it, but I would think a lot of people that might be thinking about trying it don’t know about what you’re offering and maybe it’s different.

Andrew Hill, PhD [35:55] Yeah. TMS is useful, but it’s got kind of a narrow use case that’s been proven out. A couple of things on TMS, TMS is magnetic stimulation. It zaps the brain with magnetism and creates a likelihood or a reduced likelihood of the brain firing in the place it’s zapped. TMS works, the literature shows that it works for depression. That’s about the only thing that it has good literature for, but it works for about two thirds of people, not everyone, and it produces a transient effect. So it takes a few weeks or months to get the effect in. TMS is actually somewhat painful for many people and kind of expensive. And then once the effect shows up, you get a six to nine month window of depression lifting, and then it creeps back in. So TMS, I think, I’m not a clinician, I’m a scientist, but my perspective on this is TMS is best used for acute medication resistant depression when you’re crisis to create some breathing room so you can architect other support for your depression. It’s not going to cure it as far as I understand. Neurofeedback works more slowly and gently so you don’t feel the process, but it changes your brain. So after you do three or four months of neurofeedback, whatever you’ve gotten done is your new baseline. So it’s a much more gentle process of teaching your brain to change and much less about imposing briefly a state. And so I’m a big fan of neurofeedback, but I’m also, I think TMS can be very powerful. And I know lots of therapists that use, you know, psychiatrists that use TMS for depression and for OCD and a bunch of other stuff. It can be very, very powerful. But it’s definitely a medical intervention. It’s definitely somewhat invasive. And it has the costs of being kind of painful, kind of takes a while. And it’s very expensive to do TMS often unless it’s insurance covered. So I’m not a huge fan of things that are invasive, only because I’m a scientist and biohacker. I want you to do things that are gentle, progressive, and only give you positive effects. So I tend to lean away from TMS, TDCS, TACS, and all of the sort of more active zapping technologies because they can work, but they don’t work any better than classic neurofeedback, and they often work worse, and they’re much less controllable or predictable if you get side effects. Neurofeedback, if you get a side effect, and that happens, you might train the brain and feel weird afterwards, feel wired or tired and it wears off later on that day or the next day you’re back to where you were and you’re like that was kind of weird I felt kind of wired after that okay let’s adjust so other techniques might be more pushy and harder to adjust as you go so I’m a big fan of this gentle iterative slowly move yourself in the right direction versus aggressively impose something from the outside all at once so I have seen tms work but unless you’re in really acute crisis you’re medication resistant, you’ve tried lots of stuff. I’m not sure it’s the best solution. I’d almost rather you start doing sleep hacking and track your, your stress response and your mood, do some HRV biofeedback, maybe some neurofeedback. Those are all likely to make changes cheaper, more rapidly in a less adversive way and safer.

Dr. Mark Leeds [39:12] Yeah. Yeah. There’s also a lot of excitement now about psychedelic therapy, including ketamine, which is not really psychedelic, but it’s available now, and then upcoming things like psilocybin and other things. Of course, where we have the option to not use a drug for treatment, that would be ideal, especially, like I said, with the benzodiazepine tapering and withdrawal patients, they cannot tolerate drugs. So we can’t say, you know, we can’t say try ketamine. I mean, it does help some people, but it also does cause a reaction for people. And I definitely would not tell anybody tapering off the benzodiazepines to even consider using any kind of psychedelic drug because that would have a horrible reaction.

Andrew Hill, PhD [39:57] Besides, somebody who’s had a dysregulated relationship with substances for a long time, they have many times, there’s this, part of the problem may be sort of an external locus of control, looking for solutions outside to fix the thing. And that means that you might go from one drug to the next looking for that magic. I have clients who’s come to neurofeedback because it’s a tool and then I’m watching them talk to their psychiatrist and shift medication every two weeks looking for something to create some new experience. And it’s not that there’s something that there’s some big suffering they’re trying to fix. They’re just looking for like the magic or the edge. That’s kind of risky. There’s nothing that works that way for people. So back to basic principles, get the resources of sleep, stress, and attention sorted out. And then the other stuff tends to take care of itself.

Dr. Mark Leeds [40:43] Yeah. Yeah. The switching of medications, switching psych drugs, I think is not only not helpful, but highly traumatic for a lot of people. You know, you’re kindling, you’re traumatizing the central nervous system by, here’s one drug, let’s pull it away, give another drug. And just having overlapping withdrawal and toxic effects. It’s really a bad idea to go from one psychiatrist to the next and each one changes all your drugs every time.

Andrew Hill, PhD [41:08] It’s huge. It’s a big problem. And you get these polypharmacy effects where folks are seeking multiple drugs from multiple providers and it causes major problems. You know what I will say about prescribed substances, prescribed drugs, especially antidepressants and things, is brain mapping can show you how those drugs work in your system. Actually, not just antidepressants, but stimulants. If you’re wondering if your Adderall works, do a map with and without it. You can see it working. It’s really obvious. And things like antidepressants, which are hard sometimes to get a good fit with people, about 10 or 12 days after you start taking an SSRI, you can see the changes in the brain that are going to show up and be felt a month later. So you can get an early screen and figure out what direction the drug is pushing you in sometimes too. Or you can look at your caffeine consumption or alcohol consumption and look at real time. And what is it doing the speed of processing, anxiety features, executive function features, performance? And I can’t tell you the number of sort of dirty mapping or contrast maps I’ve done with folks. I have the clean one and the caffeine one or the Adderall one, the cannabis one, the alcohol one. So many. And here’s one thing about brain mapping or QEEG. When I teach you about yourself using your own brain data, I’m not telling you anything you don’t already know usually. I’m like, hey, here’s a thing which often means X. You’re like, oh yeah, that’s me. Okay over here this can mean why oh yeah I experienced that so when I show you your brain clean and then with you know a substance in it you’re like oh yeah that is how I feel with that substance and it can be really crystallizing for your relationship with some of these compounds so you know learn take agency yeah learn about your brain

Dr. Mark Leeds [42:46] No no with ketamine they claim that one of the one of the effects of it is neurogenesis where you have the dendrites the little spines between the things between the neurons that connect and communicate, that those will grow and form new connections. Could neurofeedback be used synergistically with ketamine therapy to get a better result than you might get with either one separately, possibly?

Andrew Hill, PhD [43:13] Sure, sure. But you’re remodeling dendrites every day, all the time anyways. Yeah. I mean, if you went and did one piano lesson, every single hand area, every single cell has moved in the hand area with one piano lesson. And plasticity is always happening. Even someone who’s in their 60s and 70s is making six or 700 neurons a day. So you’re not really ever at a lack for plasticity. This is one of my complaints with the microdosing psilocybin stuff is everyone’s doing it to bring up plasticity. You don’t need more plasticity. You need to shape it. I’d rather you sit and meditate for 20 minutes a morning or 10 minutes a morning or go for a walk, which is hugely plasticity supporting and do some neurofeedback. So again, it’s that seeking the external solution. I think a lot of folks are like, Ooh, here’s a thing. It’s magic. It’s my edge. Well, no, it’s kind of a dysregulated relationship. You’re looking for a thing to support you, but it might not be. So yeah, I, the ketamine reset thing seems to only happen if you have the infusions too. So these days there’s a big push towards the lozenges, which are S-ketamine, one half the molecule, but they’re not dissociative, don’t have the same sedative effects that regular ketamine has. And it seems that dissociative event is what causes the strong surge in plasticity. So I know it’s not the same mechanism of action at all, but I kind of consider ketamine very similar to ECT. It’s like turn the computer off and back on again to get it to sort of reboot and create some more plasticity. And I think that ECT works just as well. And these days, ECT is still done with ultra low voltages and currents. It’s a very small amount of electricity compared to where it was, you know, 20, 30 years ago even. And it works really, really well for medication resistance and depression, really well. But it has this, you know, perspective from the 50s and 60s of being shock therapy. And it’s a different thing now. But ketamine is in the same landscape where it creates a really reliable lift of major depression. And then some people get rapid relief from the inhalers and the lozenges, but the effect is really reduced in that molecule in the esketamine compared to the regular ketamine. So I think it can help, but I’m of the opinion that it’s an intervention. It’s kind of like an ordeal. It’s a shamanic experience. You might as well go and have an experience and have some healing and reintegration afterwards. And now it becomes a lot about the people you’re doing it with and support you have and the after effects and the integration, I think that’s more important than is ketamine the magical thing? Is my psilocybin? Is my, you know, EMDR, whatever the sort of shake up the etch-a-sketch thing is. I think that the set and setting the support, the after effects, the integration are actually somewhat more important than did you find the right drug.

Dr. Mark Leeds [46:03] Oh, yeah. Yeah. You know, yeah, I agree. I think that’s critically, critically important. And people should never do any of these things, of course, outside of a clinical setting. Right. So exactly. Now, as far as the neurofeedback, how would I, you know, you’re in LA, and I’m in Fort Lauderdale, Florida. And I know that not everybody, most, there’s not too many places probably that have these brain mapping facilities and people that know how to use the equipment and the proper equipment. Where can I find that or where can anyone find that?

Andrew Hill, PhD [46:39] So there’s about 15,000 people in the world that do neurofeedback, which isn’t that many. There’s probably 15,000 chiropractors here in LA, you know, but Peak Brain Institute, my company, we have offices in New York, St. Louis, LA, Orange County, Stockholm, and London. And about 80% of our clients never visit our offices. We do most of our work from home. So we send people brain mapping systems, put a cap on your head, squirt it for the gel, and do a map with you from home. Coaches will guide it live and do real-time data acquisition. And the coaches work with you for a couple of weeks and help teach you to stick wires to your head and set yourself up for training the brain. And we work virtually. Every client gets a private Slack channel and everyone has real-time seven-day-a-week communication. So PeakBrain is kind of like the SoulCycle model for brain training. We send equipment home and coaches and screens cheer you on and nag you to do stuff and help you move through it. So yeah, we’re mostly virtual. We have all clients all over Florida. We can work with you no problem.

Dr. Mark Leeds [47:38] Would I have to get a haircut or something?

Andrew Hill, PhD [47:43] You would not. You actually having thick, dark hair is the best flavor of head to have a good EEG. Like my head, my bald head, you can find locations really easily. It’s actually hard to get clean signals off my head because the pulse moves the scalp which adds noise and also you have a thicker layer of fat and oil if you have a bald head and it creates insulation so the best eeg the best scalp for an eeg is somebody with a thick head of dark hair oh wow so it’s great I love people lots of thick hair it’s hard to get an eeg if you have like natural dreadlocks or some like really thick hairstyles you can’t use caps then you have to place individual wires throughout the scalp that way. And I do that all the time with people that have, you know, black hairstyles in the U S for instance, but generally it’s not that hard to stick a cap on the head. You’re squinting it full of gels. The gel is touching your scalp. You don’t have to like stick wires in every place. And then that’s the assessment, which is a little awkward, a little involved to gel up a whole cap. But the training process is a couple of ear clips and one or two wires at a time. So we teach you to find locations, stick them on, set the software up, get your session in, and then give us some reports afterwards and move you through that like a personal trainer would over the week.

Dr. Mark Leeds [48:56] Oh, like if a person isn’t in a location near you, like say in New York, St. Louis or LA, can they come in person and do it also?

Andrew Hill, PhD [49:04] Yes. Yep. Yep. They can come in. We train three times a week in our offices, but we encourage our home clients to train four times a week. Because you have the gear, you got the brain, we have coaches. So we get more sessions in for the same amount of time. So I have a two month standard program people start with in our offices. That’s 25 sessions, three times a week. And from home it’s four times a week. So it’s like 32, 33 sessions. And we charge the same amount in office and home, use the same software, the same hardware, the same coaches. So this is part of why my clients who are even in LA and New York often train from home because they can train at 6 PM. They can train on a Sunday. They can ask real-time help and they don’t have to worry about driving to an office, sitting down, giving a report, getting set up, leaving. So the whole process becomes much more integrated into their life and they can sit and do homework or their taxes while they’re training and then just check in with us later. So another home training, the remote neurofeedback is a big thing that we tend to do. Even in 2019, we were about 50% remote, but during 2020, we went up to about 75%. I’m not

Dr. Mark Leeds [50:10] I agree. Anything that we can do from home is always better. I just didn’t realize that you had this technology to the level where you could have someone do this at home. Because back in the old days, when I did that thing I went to, the biofeedback or whatever they called it, they were shaving little parts of our scalp to stick electrodes on.

Andrew Hill, PhD [50:34] Yeah, you don’t need to do that these days. And we can give you a laptop bag with an entire kit, pre-configured. When I got involved in the field 25 years ago, you actually need two computers to run one session because one ran signal processing and one ran a video game. You tied them together with a parallel cable. And it was like $12,000 of computers in 25-year-old money. It was really expensive to get set up. Now, for folks who are watching, this is an EEG amplifier we use for training. It’s under a grand for the hardware and the software costs about the same. So we just lend people systems. So you get a whole laptop bag and you return it when you’re done, but it’s not as technologically expensive because it’s more consumer driven, a hardware and software these days.

Dr. Mark Leeds [51:21] Oh, so people have access to this from anywhere?

Andrew Hill, PhD [51:24] They do. Yep. Yeah. If you’re in the US, Sweden, or the UK, you can come to one of our offices, get a map or do a remote map and then train remotely. If you’re in a different country, we don’t have rental programs. You might have to buy a system or I can find you a place to get brain maps. But yeah, I work with clients all over the world in 20 or 30 countries. And even in the US, most of our clients are not near Southern California, New York City or St. Louis. So we end up getting most of our clients virtually. I do a lot of podcasts. So people find me randomly all over the world and the top of funnel, so to speak, is really wide. So that’s part of why we stay virtual is because people like, I want to work with you and I’m in this place. Okay, great. And we learned how.

Dr. Mark Leeds [52:07] That’s great. And I’ll put it, of course, in the show notes, but what’s the best place for people to find you like online, your website?

Andrew Hill, PhD [52:14] Yeah. So we’re peakbraininstitute.com. You can check us out there. All of our socials are Peak Brain LA because that was the first office. And you guys can also check me out on YouTube. It’s just youtube.com slash drhill, drhill. And I do a weekly live stream every week where I’m doing neurofeedback and answering biohacking questions. So if you guys are curious, show up and ask questions.

Dr. Mark Leeds [52:36] Oh, that’s incredible. Okay. Thank you, Dr. Andrew Hill. Thank you for joining me today.