Neurofeedback and Mental Fitness Podcast with Andrew Hill | humanOS Radio

Guest

In this episode of humanOS Radio I speak with Dr. Andrew Hill. I had the pleasure of briefly meeting Dr. Hill at this year’s Biohacker Summit in Sweden. It was immediately obvious that Dr. Hill practices what he preaches, as you’ll appreciate while listening to the podcast: He is an exemplar of mental fitness, the result of which is an impressive capacity to efficiently juggle several demanding projects while still being a good guy.

Dr. Hill founded the Peak Brain Institute, where people go to train and thereby improve their brains. Dr. Hill is renowned for his skills as a practitioner of a method named neurofeedback, but other interventions such as mindfulness meditation are integral components of his work.(Check out this blog for more on the benefits of meditation!) Dr. Hill has a PhD in Cognitive Neuroscience from UCLA’s Department of Psychology and continues to research attention and cognition. Dr. Hill is host of the Head First Podcast with Dr. Hill, is Lead Neuroscientist at truBrain, and lectures at UCLA, teaching courses in psychology, neuroscience, and gerontology. Basically, he’s a bit of a boss.

Neurofeedback and Mental Fitness

So, should we think about training mental fitness as being analogous to training physical fitness, or does this comparison fall apart in some ways? What is neurofeedback, and who may benefit from it? For those of us without access to neurofeedback, what are the low-hanging fruit we can all taste as we strive for mental resilience? And as Dr. Hill peers into his crystal ball, how does he foresee the future of metal fitness training unfolding?

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Think that Greg needs to try neurofeedback to help with his mental fitness? He does too, for it will help him crank out more work in the coming months. Great news: You can help him and the rest of the humanOS team out by making a contribution. If you do, thank you so much – we really appreciate your support! And no worries if you can’t chip in, the important thing is that you benefited from listening today.

Transcript

Andrew Hill - 00:06: If you have a brain, then you're probably a good candidate for neurofeedback, just like the human body, you're probably a good candidate for exercise and for staying active. It just ends up becoming, where do you identify the performance goals or the bottlenecks to be?

Kendall Kendrick - 00:25: HumanOS. Learn. Master. Achieve.

Greg Potter - 00:33: Everybody knows about the importance of physical fitness, but today we're going to speak about mental fitness. Our guest today is Dr. Andrew Hill. Dr. Hill has a unique skill set that makes him especially well-suited to speaking about this subject, and he founded the Peak Brain Institute, where people go to train their brains, much like many of us train our bodies at the gym. Dr. Hill has a PhD in cognitive neuroscience from UCLA's Department of Psychology, and continues to do research on attention and cognition. Dr. Hill is host of the Head First Podcast with Dr. Hill, is lead neuroscientist at TruBrain, and lectures at UCLA, teaching courses in psychology, neuroscience, and gerontology. With that background, Dr. Andrew Hill, welcome to humanOS Radio.

Andrew Hill - 01:17: Thanks very much for having me, Greg. Appreciate it.

Greg Potter - 01:18: Start by telling us where your fascination with the brain came from.

Andrew Hill - 01:22: Yeah. So, I guess, when I was growing up I was one of those kids who always took everything apart, so to speak, and had to sort of figure out how it worked. That included to seeing odd human behavior, and when I was somewhat young, in eighth or ninth grade, my younger brother actually had sustained a head injury and I saw a pretty dramatic change in consciousness from a pretty minor injury. It was not an insignificant injury. It produced a massive change. He was in a coma for nine weeks. He had to do some relearning of basic skills after he came out of it, so it drove the point home that we didn't know a lot about what was happening in the brain, and it had massive impact when small shifts happen in that tissue, and that sparked my interest in neuroscience to some extent.

Greg Potter - 01:57: I first want to consider the idea of mental fitness. There are many motor skills that can be trained like endurance, strength and power. Do you think about mental fitness in similar terms, and which mental fitness skills do you think most people would benefit from training?

Andrew Hill - 02:11: When thinking about mental fitness, you have to drop a layer below the skill we're talking about. What I mean by that is there's often a resource that supports a specific skill, and if you practice the skill in a very intentional, effortful way, you get better at the skill. But if you don't, if you practice approximations of the skill, if you will, you don't get better. So an example are these cognitive training batteries, these brain games, where you go online and do pattern matching or visual attention games and memory games and things like that. The vast bulk of the research on those things suggest that there's just no real effect in terms of stretching the brain. It gets you a little bit better on the game itself, but there's no skill transfer to other environments or games where you would expect the same resource to be changed. It doesn't seem like there's any real change.

02:55: So in terms of doing exercises like that, even things like Sudoku and crossword puzzles and things, those don't really have too much of an impact. So the exercise metaphor breaks down a little bit. It's somewhat accurate in that the brain, again, patterns to optimize its activity based on what you're doing with it, but you have to be a little bit more specific in some ways. There's a couple classic ways that you sort of drive down and build a bigger resources, but you have to think about it in terms of your stress response, your tension response, your sleep regulation and architecture, as opposed to how focused you are. How focused you are is a high-level, complex feature that includes all kinds of physiological and psychological things, and the best you can do to some extent is not worry about the specific resource and train the whole foundational resources so that when you want to control the specific mental resources, you have more horsepower and more resilience and flexibility in those resources. So it's a slightly different perspective than your fitness.

03:48: Another slight difference is, once you do enough direct brain training, be it mindfulness or neurofeedback, which is what we do a lot of at Peak Brain. Once you do enough changing of the brain resources, the brain is then always practicing those resources and tends to maintain different resources a lot better than the body fitness does. You can have a phenomenally in shape in six months of aggressive gym exercise in the body, and then if you take six months off, there's a fairly large slide off of those resources. In the brain, you do six months of aggressive work, and now you have a different regulated brain at the end of that time that has more things it can bring to bear, and the next six months can actually soar even higher in performance, even without more exercise because the brain is integrating and using all of these new resources a new way.

04:30: So it's a slightly different perspective, but the part that matches is the idea that we have control. Fitness is all about taking control of our body and knowing what to eat, how to exercise, how to sleep, how to maximize the machinery, and we have the same control and agency when it comes to our brain, we just don't necessarily know it. We can do things like meditation exercises, neurofeedback, optimize our nutrition, our sleep for brain health or aging health, we just don't always have that perspective. So the fitness perspective is hugely important and congruent with brain health and performance, but the workout metaphors aren't always necessarily congruent or accurate.

Greg Potter - 05:03: To briefly summarize, whereas in exercise the adaptations are very specific to the type of exercise that you do, in neurofeedback you're focusing on foundational things that then pave the way for better responses to the more specific work later.

Andrew Hill - 05:16: Many neurofeedback people work that way, in terms of working out the whole brain, doing broad protocol. Some people have very specific ideas of how the brain works, and they have magic boxes that go in and do magic things. I don't like that perspective. I like to go, "Okay, let's just assess your brain fitness, like you would your body walking into a gym," but we look at things like your speed of your alpha [inaudible 00:05:32], your alpha frequencies, and the ratio of your alpha-1 to alpha-2, and the ratio of your theta to beta waves, and if you show evidence of sleep deprivation or injuries. So it's a similar perspective, and we do work on specific things for people, but we know less about the specifics. Oh, you have a torn bicep or a rotator cuff, or you want to get some better abs. You know what to do to get there in the gym.

05:51: It's almost like you're walking into a fitness center with somebody. You're meeting a personal trainer, and together you build a workout. You then exercise, and actually, in neurofeedback the exercise is almost purely involuntary, which is strange. In mindful and meditation it's very voluntary, but in neurofeedback it's the opposite.

06:07: So you get this exercise plan set up, and you exercise, and then later you determine, is that the right direction to push your brain? Do you feel more resilient, sharp, crisp, flexible, less anxious, better rested, whatever the goals are, and you evaluate the direction of change and the direction of resource shift in neurofeedback and see if it works for you. And in meditation, too. Does this meditation process seem to work for me? A very classic instruction. Don't believe any of your teachers, just do it and see what happens and only take from the process what you find to be true. That's a voluntary cognitive thing in mindfulness and meditation. In neurofeedback, we just evaluate. Did you sleep a little better or a little worse? A little more focused or less focused? More resilient, little more on edge? What's going on in the next day after you train? And we get a subtle hint in terms of what resources are shifting and then push your brain again, in neurofeedback, and usually we do about 40 sessions in three months or so.

06:53: And after that you often get a permanent change, especially in the big resources, and that's really valid, what you said about focusing on the broad things. Those are the things that tend to change really reliably. Your attention performance, your stress response, your sleep regulation, reduction in seizures, reduction in migraines. All the gross features, when doing brain training, are the things that generally are the most permanent and the most reliable changes we get, although we can get pretty far field and try very specific experimental things with people based on what their goals are and just evaluate results. So you have this freedom in brain training to try things.

Greg Potter - 07:24: Building on the exercise analogy, with exercise, over time, to keep improving your ability to perform a given skill, in general you have to focus on more and more specific exercises. So perhaps you start exercising, and you go into the gym and you do some leg presses and that improves your ability to lift weights in the squat, but then as you get stronger, you need to do tasks which more closely mimic the squat to keep improving. Is there an increase in the need for specificity, and then also, thinking about other training parameters, so for example, the total volume of training that you're doing, does that need to change over time to continue your improvements?

Andrew Hill - 07:59: That's a great question. I would say it's not exactly the same metaphor again, in that, yes, you can be more specific, and often you are, but I would say that really the core of the process is individualizing, is targeting things anyways. Every brain is different. Every brain has a slightly different presentation. And so while you start in really classic, foundational, let's work the whole brain out ways, you are really developing a set of customized protocol for every brain, ideally.

08:21: Also, as you train, the brain reorganizes itself, so you get a lot of the heavy lifting, if you will, done by the brain itself. So you are somewhat specific, but the brain can also almost change infinitely in a way the body maybe can't, and the brain changes a little bit faster too. So you have some opportunity to just keep the same pressure on and keep change happening.

08:41: Now the other piece of it is the learning signal is very different in terms of activating a muscle versus activating the brain, and in both cases we're causing learning, ideally. If we aren't tearing a muscle, we're just causing it to learn and change its composition, essentially. In the brain we're causing synapses to change and groups of cells to fire differently. The core way the training, the exercise, happens in neurofeedback is operant conditioning. So it's not this effortful exertion. We have to keep loading up heavier and heavier exertion to see how much the absolute resource can handle, then stretch it and caused it to grow. In neurofeedback, think B. F. Skinner's pigeons, not Pavlov's dogs. So it's conditioning, but it's conditioning something that already exists. You're shaping up or down a resource.

09:21: So let's say you're finding yourself too easily distracted, and we discover that you have high theta waves, which usually means you're easily distracted. Well, your theta waves aren't static. They're always changing moment to moment. So whenever they briefly trend down, we would applaud the brain with audio and visual feedback. That's the reward. But then we move the goalpost every 30 seconds or so in shape, successive approximations closer and closer to what we're trying to get your brain to do. So there's never an experience of pushing the weight up all the way. It's always this process, when watching a neurofeedback screen, of a game or a stimulus stuttering, turning on, turning off, turning on, turning off, and you don't necessarily know why, and you're not in control of it. But your brain is being applauded every time it does the right thing, and then gradually it's being applauded for more and more change in a specific direction.

10:04: So then the next day your brain just does more of what it was getting input from the day before. Oh, hey, I got a lot of cool music volume increase whenever I dropped my theta yesterday. Let me drop my theta a bunch today and see what happens. And you suddenly feel the effect of your theta being reduced the next day, feel a little more crisp, little more alert, a little more focused, and you say, "Hey, that worked pretty well. I feel X, Y, and Z," and we train you again in that direction. And after doing a bunch of those conditioning sessions, the brain ends up picking up the new resource and regulating with much higher control in the direction you want it, and eventually it's a permanent change

Greg Potter - 10:36: That's a very comprehensive answer, and you've already answered a couple of questions which I had coming up.

Andrew Hill - 10:41: Okay.

Greg Potter - 10:41: A couple of things that you mentioned.

Andrew Hill - 10:43: Yeah.

Greg Potter - 10:43: One of them was the different types of brain waves that there are within the EEG spectrum. If we turn to that, can you first describe exactly what EEG measures, and then also the EEG spectrum and the kinds of brain states that each frequency band are typically associated with?

Andrew Hill - 10:59: Yeah. Great question. So, it's electricity. It's a bursting or a firing of cells, and the cells tend to fire rhythmically at certain rates, labeled hertz, Hz, which is firings per second. The cortex, the top layer of the brain, is comprised of something called minicolumns or microcolumns, which is actually the same label. One's size, one's electricity. And these columns are about 30,000 little neurons and the glial cells and support cells that make up this local neighborhood, and these are essentially CPUs, and we have millions and millions of these things throughout the brain. About half of these are at right angles to the scalp and to the skull, and when they fire, you can measure that dipole, that discharge electricity, from outside the scalp. And so all the ones that are perpendicular to the scalp produce EEG in their firing rates. When more of these columns are firing, it's higher amplitude EGG. When they're firing faster, it's a faster frequency of EEG. And different groups of cells tend to make different types of EGG and are generators for certain sources of EGG.

11:56: We make all brainwaves all the time, and these electricity burst start very, very low, close to zero cycles per second, and they go up in human brains to a couple hundred hertz, couple hundred cycles per second. Classically, EEG is talked about from about 0.5 hertz up to about 40 or 50 hertz in sort of the typical human range. There are things above that, but they're hard to measure. And in order, going from slow to fast, delta is slowest. Delta's a autonomic rhythm, so the brainstem uses delta for breathing and heartbeat, and when we're deeply asleep and not dreaming, we're in slow wave sleep, it's a heavy delta state. You're still making some delta when you're awake, but not very much, and certainly not when your eyes are open. You don't see a lot of it dominating a signal in the cortex, and if you do, somebody's really sleep deprived or maybe brain injured, so it's a problem, but it's really a core frequency that you live in instead of think in. It's a physiological regulatory frequency.

12:46: Next up in frequency is theta, which is about four to seven hertz. Delta's like half to four, and theta's four to seven. These are a little arbitrary, these ranges. And theta's involved in a bunch of things. It's receptive attention, in some ways, taking things in. It's pulling access out of memory, recalling ideas or memories. That's a fast, at 6.5 hertz, we think. Broadly, it's like the opposite of focused information flow for a lot of the resources. It's a disengagement of some tissue. It's a special type of desynchronization so that information flows from the brain. It's not this linear cognitive state. It's a receptive state or a creative state.

13:19: For many people it get stuck on, though, and you end up being very driven by stimulus, right information, greedy. You're novelty seeking and everything grabs your attention if you have high theta, and you have a really hard time inhibiting what happens in your body and mind, and we often call that ADHD. If we have a high theta state, you have some motoric body hyperactivity, often you're fidgeting, or you have a problem guarding your working memory, and so you tend to have bursts of theta and it distracts you and something knocks an idea out of your head or you confused or forget something, or you know, squirrel over there and then you forget what was happening. So that's a high theta state. But again, we need data because we want to recall memories, be creative. When it goes up and stays up, that's a problem.

13:58: There's like five or six different things in the brain we call alpha. Classically, we would divide it into at least two things, slow and fast alpha, where slow alpha's an idling frequency such that if you close your eyes, the visual system in the back of the head goes into alpha. It idles. There's many other things that are alpha, but that's a classic example. Slow alpha's like 7 to 10, fast is maybe 8 to 12, 8 to 13 hertz. Fast alpha is a flow state, and it's that quick, almost creative mind where you're in the zone, you're flowing from one thought to the other. It's a good state, usually. In that same range, somewhere in alpha we also have the mu wave, which is an alpha wave that's about mirror neuron activation, and there's a few other interesting things in the alpha frequencies.

14:35: Then we're to cognitive thinking frequencies, really, where we start with beta on 12 hertz, and somewhere in the 12 to 18 hertz are the different beta ranges where we're thinking a lot, and 12 to 15 is calm focus, and 15 to 18 is sharp focus, and above that, maybe a little stressed if you're producing lots of fast beta waves. But I'm putting all these things in cognitive terms, and I would say only a fraction of the EGG is dedicated to cognitive things. A lot of body stuff is happening. Sensory things. You don't perceive the sensory transduction of information in your eyes and-

Andrew Hill - 15:03: ... perceive the sensory transduction, that information in your eyes and ears and skin into the brain, you perceive it only when it hits the sensory cortex or maybe the thalamus. So, you're not perceiving a lot of what's going on until things rise to the top level of the brain, the cortex. So, a lot of the EEG is about processing all the other body stuff going on as opposed to what you're thinking about.

15:20: To that end, we have all of these EEG waves all the time, so while you may make a lot of beta and you see you're really wide awake, you also make all the other frequencies. Beta, I would say, goes up to about 38 hertz, and above beta, 38 to 42 or 50 classically is called gamma. Gamma is a very fast frequency which is involved in a bunch of things like recruiting distant assemblies in the brain to coordinate in time to synchronize faster somehow than they could by the actual wiring in between them, there's some almost instantaneous synchronization in distant brain regions that seems to happen using fast frequencies and gamma.

15:53: Gamma shows up in weird places of research like consciousness research. So, if you're a hardcore Tibetan monk that have been meditating for most of your life, your gamma connectivity is really high compared to average. If you're a schizophrenic who's actively symptomatic, your gamma connectivity is really low. The coupling of gamma to theta, again theta's around 4 hertz, and gamma's around 40 hertz, they reign together. They synchronize. When that happens, it's great, you're conscious. When you break that time coupling of gamma and theta, you produce unconsciousness with anesthesia.

16:26: So, now there's an EEG measure that can look at the phase synchronization of gamma and theta. The bi-phasic or bi-spectral index, and determine depth of anesthesia to determine if you're conscious or not. So, in the past few years there's been a really dramatic reduction of the amount of awake while in surgery anesthesia events because you can actually tell if somebody is conscious looking at their EEG reliably these days.

16:47: So, that's the spectrum, no pun intended from 0 to about 40. Delta, theta, alpha, beta, gamma. But, from the point of optimizing brain health, we really focus 2-38 range roughly. You can't measure above 38 using consumer or even sleep lab grade hardware. It doesn't record above 38 hertz very well. So, a lot of people in the bio-hacking world are talking about training gamma because it's a consciousness frequency but doesn't really work with passive electrode that don't have little amplifiers at the scalp because there's something called a [1/f 00:17:17], or amplitude over frequency rule such that the slow waves, delta, theta, et cetera have a much higher amplitude than the fast waves, that's beta and gamma for the same amount of electricity. So, one giant delta wave is the equivalent of many, many, little beta waves in terms of electricity.

17:31: This means as you go up in speed, you go down in amplitude and the wave and then the stuff is inside the head, and whenever these waves pass through the scalp, the skull, the meninges, the things that wrap the brain, you get attenuation, dropping in the amplitude. And gamma, things above 38 hertz, they're so small to begin with, that by the time they've gone through all the layers of tissue, they basically dropped below the noise floor of recording equipment, unless using very sophisticated equipment. So most people training gamma in the biohacking world, they're not doing what they think they're doing, and they're getting some effects from modifying other frequencies like theta and alpha, usually, I think. But that's the rough shape of the EEG landscape, so to speak.

Greg Potter - 18:08: That's a terrific and very comprehensive overview.

Andrew Hill - 18:11: So I can't stop teaching [inaudible 00:18:13]

Greg Potter - 18:14: You touched on amplitude there. Can you also mention the relevance of EEG power within a certain frequency band? Is it a question of more being better?

Andrew Hill - 18:23: Yeah, it's not usually. Great question. It's really a question of are these things balanced. So amplitude or power, two things are really related, power is just the square of amplitude. The reason we use power in the EEG is because squaring the amplitude accentuates the 1/f rule and we see the spectral distribution of amplitude versus frequency in the signal a lot better. The average frequency of waves is important. So is the amount of each band, the power of each band. But you would care a little more, in classical EEG terms as well as biohacking terms, about the ratios of power, not the absolute. Because if your skull is a bit thinner or thicker than average, the absolute power may be a little bit different than average. So, when doing brain mapping or QEEG, we record the averages, the resting baselines of your brain, eyes closed and eyes open, and compare them to other people's brains, eyes closed and eyes open, and end up with relatively nice set of heat maps, or z-scores, about how unusual your brain is.

19:13: But it doesn't mean that we have a diagnostic "Aha, this is true." The same way we would if we had a broken bone or profoundly high cholesterol, that we'd have a really serious, almost conclusive, valid read on the data. In mapping the brain, it's more like, "Oh, this is an unusual statistic. This often means x, y, or z. This may be getting in the way for this person, but maybe not." And so you have to be a little cautious to avoid over interpreting the data, but certain things are very valid. Certain things are less valid. Some things of high specificity, like the ratio of theta brain waves to beta brain waves, is a very, very valid marker for executive function. And you can blindly sort data, ADHD and non-ADHD, into the correct buckets 94% of the time using a ratio of theta to beta on the top of the head. You can use similar measures of theta to beta with people with memory issues, elders, who are wondering if they're gonna have some significant memory issues. The ratios relative to their population predict progression versus non-progression to more serious dementia level memory issues.

20:12: The average speeds of your alpha, to get away from amplitude into speed or frequency, also track with aging. So as you lose cell bodies, you have fewer cells firing, so reduction in amplitude, but you also have reduction in frequency. So the brain slows down later in life, and you see that change. They can use it as a measure of performance, because other things show up as the alpha speed slows down. One of the things alpha is, besides an idling frequency, is the neutral, so you shift through it getting to any resource, to some extent. And if your alpha is running slow, you end up with weird things like word finding issues and your brain kind of drifts here and there and drops into neutral a tiny bit too easily. So it's more of the relative. Is your alpha high or low compared to what it should be for your age? Speed or if amplitude is your ... are your ratios or frequencies where they should be?

20:57: As kids grow and they're early in their life, their skulls get thicker and the amplitudes drop dramatically, so we see big age effects. Below age 12 and above age 65 or so, there's change year to year in the EEG, but between those years, there's not. So your EEG is actually relatively stable in terms of an age graded metric across the life course. So you can actually look at the numbers and get some sense what they mean, but also you can train them, see how they change, see how it feels, and get a much better sense for yourself. You can really be experimental and figure out what this excess theta or fast alpha or a stuck little spot of beta might mean by being systematic, investigative, looking at your brain, come up with some ideas, trying some things, evaluating them, and gradually developing a customized workout for yourself.

Greg Potter - 21:41: You mentioned z-scores there, and brain mapping relative to peers of your age. Can you just briefly describe the QEEG process and how you go about that?

Andrew Hill - 21:50: Yeah, sure. There's a great paper by Jack Johnstone and Joy Lunt from 2005 called Clinical EEG Database Characterization, it's a good overview of the space. But QEEG refers to quantitative, and in the clinical EEG space, what we mean by quantitative is a database comparison. So there's a handful, five or six different commercial products, that have between hundreds and thousands of EEGs in them, across all sorts of ages. So probably the largest at this point, called [Neuroguide 00:22:17], which has several thousand brains in it, and it has individuals that are between ages 5-10, 10-20, 20-30, all the way through the end of life. All these people, these hundreds of cases at each age cohort, they're heavily clean, no meds or injuries or anything else, and they have neuropsych testing done.

22:35: Then, when you come in, we record your resting brain. So we put a swim cap on your head, squirt it full of gel, have you sit eyes closed, then eyes open, for several minutes each, and pick up your resting relative power of your brain waves. And then we compare that to the database of people. It's not really a direct comparison to all the people who are your age, it's kind of like there's a mathematically average brain created in that database, and since age is the biggest thing that changes across EEG, it's sort of a mathematically average brain plotted on what's called the regression line in age. It's the change across the data in age. And you are compared to that. There probably are some direct comparisons, or probably several dozen.

23:14: There's also much broader amount of data about how most brains often are. And then we get maps, or standard deviations compared to a population as a z-score. So when you hear z-score, just think standard deviation, but standard deviation compared to one particular reference. In this case, it's the database of subjects. So when you're more than about one and a half standard deviations or z-scores out of typical, then it starts becoming interesting. "Oh, this pattern is probably getting in your way, or you're aware of it in some way, or it's some specific resource you probably want to work on," and so you end up creating hypotheses from the brain mapping process, the QEEG process, about all the different things that might be performance bottlenecks for the individual.

23:52: And then the way we work, at Peak Brain, is to say, "Okay, here's what might be true. Let me know what is true for you, what's valid, probably, based on this data. And kind of more importantly, what do you want to work on? Which of these things are targets for you? What else do you want to work on? Where are your goals in health and performance?" So again, the perspective is agency. "Oh, yeah? I can change my brain? Great. What should I do?" Does your sleep need to be modified, your attention, your creativity, your immune function, your ... All kinds of things can be modified with neurofeedback, so it becomes an interesting process of shining a light on what may be true, based on your actual data ...

24:24: The data is real, the EEG is real, but the interpretation of, "I wonder what this two standard deviation excessive theta means. Hey, that often means some attention difficulty. Oh, you're ADHD? Okay, great. I think we found what we're going to work on then." And so you go through all the data and find the likely suspects that represent bottlenecks in performance. And then I work with clients to help them figure out which ones are most [tractable 00:24:44] and we eventually change them. After 24 to 40 sessions of neurofeedback, there's a permanent change for most people. We usually get about a standard deviation of change in 20 sessions of training. So if you've got significant ADHD, you're two to three standard deviations up in your theta, maybe low on your beta, 40 sessions of neurofeedback... At the end of that time, you don't have those signatures in your brain. You don't show the problem on a behavior test, and you no longer interrupt your wife and fidget in a boardroom.

25:11: We got really dramatic changes in behavior, as well as physiology, as well as subjective experience in about three months of training. We tend to do 40 sessions in 3 months. We see changes in this mapping as well, as we go. We tend to do about three maps, at least, in that time frame. And so we see the amplitudes and frequencies all shifting as we exercise them and we just make sure that they're changing in a way that is sane to us, it matches what we think we're getting for your brain, for your goals, based on what effects you're reporting subjectively. We dip back into the physiology periodically to make sure that we're actually clear about what's happening in your brain.

Greg Potter - 25:41: Those sound like very impressive results. I suspect that everybody might be able to benefit from neurofeedback. Can you just mention the populations who have been studied most?

Andrew Hill - 25:52: Yeah. The low-hanging fruit in terms of the research backing and the clinical applicacy, that Venn diagram of the sweet spot, would include ADHD, sleep, anxiety, and seizures. There's good background for both of those in literature and we can usually work profoundly well to minimize symptoms in those areas in the clinics. Other things it's also very effective for are things like TBI, traumatic brain injuries, and PTSD. We do a lot of work with veterans, where ... Peak Brain is part of a Homecoming for Veterans program, where if you've served in any sort of armed forces and have PTSD or blast injuries as part of your service, Peak Brain, it's a network of neurofeedback people called Homecoming for Veterans, where we essentially provide free training for people. We do, usually, a full course of 40 sessions for veterans and can almost always really dramatically reduce brain injuries and PTSD.

26:36: Now, with injuries, you often have to do a little more training than that. It takes longer to make those changes stick with the significant injuries. But a lot of clients who have various types of injuries or things like that, and it does actually work on changing the brain over time very effectively. Post-concussion syndromes, we have a lot of people with profound anxiety for various reasons, including things like OCD and PTSD that are just coming up for whatever reason, and we usually identify those in the mapping and then train them away.

27:02: So again, low-hanging fruit are ADHD, sleep. Sleep is probably the easiest thing to work on for almost every neurofeedback approach, and we get sleep improvements whether or not you want them as you go with neurofeedback. It's like you work out and sleep improves, period. That happens in neurofeedback. Your sleep compresses, gets deeper, your dreams get more interesting, for almost everyone. But we work on all kinds of things. If you have a brain, then you're probably a good candidate for neurofeedback, just like if you have a body, you're probably a good candidate for exercise and for staying active. It just ends up becoming where do you identify the performance goals or the bottlenecks to be and then it's a guessing game, a little bit, trying to match that to what we see in the data or to protocols that might push on that resource until it moves.

27:40: So, I can give buckets and categories. About a third of my clients are peak performers, executives, creatives, athletes, trying to really crank things up. About a third are kids with ADHD, autism, developmental issues. About a third are everyone else, ADHD, brain injuries, yada yada yada. But it doesn't really matter what you come in for, because, "Oh, you have a resource limit you've identified? Great. Let's dig in. Try to quantify it, try to push it around. Once we get it moving, now we can change it. Now we can make it go away, ideally. Or make that resource strong for you if you're trying to crank up vigilance or creativity."

28:11: We have some really great Peak Performance protocols we use for deep creativity, really nice profound relaxation states that are good for all kinds of things, including body healing. Often people that are doing performance work are stacking 10 or 15 different interventions, and so adding in neurofeedback tends to make everything work better. You get the plasticity boost of neurofeedback. One single session of neurofeedback produces plasticity increases that are measurable with evoked potentials the same day. It's a really obvious effect. So as long as you're training, you're bathing the whole brain in plasticity factors and getting change everywhere. You are going after specific things and trying to make specific resource changes, but also anything else you're doing to your brain in your life, therapy, be it psychotherapy or physical therapy, or working out, or language learning, or studying, or whatever it is tends to work better because the whole system is being worked out.

Greg Potter - 28:58: You mentioned plasticity there. I'm guessing that those factors that contribute to that are things like [BDNF 00:29:03]?

Andrew Hill - 29:04: Exactly, yeah. So BDNF ramps up dramatically in the hippocampus whenever there's a strong plasticity ask in the brain for various reasons. This is, of course, the main thing that lifts depression when people have it, anti-depressant effect from anything. One of the things that happens in neurofeedback, I mentioned, is an increase in dreaming. This usually happens like an increase in crazy, vivid, travel-themed dreams seems to be a very common report. I'm pretty sure that's because we're getting BDNF increases in the hippocampus, we're hitting place cells, and that's encouraging a travel- themed dream.

29:31: So probably, BDNF directly, I mentioned evoked potentials. And evoked potential's done a bunch of different ways, you provide a stimulus to the body or the eyes or the ears, and you get the brain to jump a little bit, and you measure how it's responding. There's an area to this called motor evoked potentials, MEPs, where you zap the cortex, like the hand area. You put a little magnet over the scalp to the right side, over the hand area of the cortex, and when you pulse a little magnetic burst, the hand jumps. You get a motor activation. So it takes a certain amount of energy to cause the cells to fire, a certain amount of magnetic pulse.

Andrew Hill - 30:03: ... energy to cause the cells to fire, [inaudible 00:30:03] magnetic pulse, and you can measure this as the level of resistance to change. Kind of like plasticity. After a single session of neurofeedback, the magnetic energy required to provoke these cells to fire is dramatically reduced, so it's a really clear change in plasticity. The molecular substrates that are causing that, things like BDNF, are really working one layer below what EEG scientists or clinician would think about.

30:27: In fact, I think there's a lot of false importance attached to neurotransmitters often because the absolute level of a neurotransmitter often doesn't matter in the slightest. There's no such thing as a chemical imbalance in the brain, first of all. That's just marketing from drug companies. Never been demonstrated. It's just easy language. It's an idea that is sexy. Doesn't actually probably exist. The example I give my students when I'm talking about this is Parkinson's is a failure in dopamine signaling to some extent in the basal ganglia. It's an over simplification, but it's a failure of dopamine signaling that only shows up when you've lost 75% of your dopamine neurons. Up until that point it's asymptomatic.

31:01: What happened in the first 75%? Are those dopamine neurons not necessary? No, it's just that the system's able to tune itself to a huge range of absolute values. As long as you have some neurotransmitters and they're changing relative to the signaling going on then there's a range that can be sniffed by the receptor, the synapse or whatever can tune itself to the range that is being expressed in the signal. Failure of signaling is the issue, not the absolute level of the signal in the slightest. It's just a bit of a stocking horse, in terms of thinking about well what's the actual neurotransmitter.

31:33: They're myriad and incredibly complex. We don't really understand neurotransmitters. Most drugs we talk about, "Oh, it does this, that and the other", we're not right, or it's a much more nuanced picture than we're describing. Like serotonergics just don't work, SSRIs don't work how the television commercial shows us that they work. They don't actually raise serotonin. They lower serotonin to a large extent because serotonin neurons that send serotonin have auto-receptors that sniff the amount they're sending. When you boost the amount in the synapse with an SSRI you get down regulation of that sending, drop in sensitization. It's a very complex process, but we say, "Oh, serotonin's the feel good neurotransmitter. We need to raise your serotonin." Completely wrong.

32:13: It's a lot more correlated with anxiety, high signaling serotonin is a lot more of an anxiety issue. With serotonin there's four or five different types of receptors with dramatically different effects in mood, sexual function, digestion, stress, learning, the list goes on. I stopped trying to explain it and really work on the phenomena of EEG and the phenomena of results of getting performance improvements and I try not to believe the data too much. It's like, okay, let me come up with six ideas about how your brain works on your EEG, based on what you're describing, let's test those ideas based on these protocols we're gonna try to exercise your brain, "Oh, good, we got results", doesn't mean we should believe the models we're using to get those results. The math is not the territory here. The bio-hacking space and the quantified cell space it's really tempting to believe our data. It's data. The meaning we make must be cautious from that.

Greg Potter - 33:01: We're impressionable aren't we?

Andrew Hill - 33:02: We wanna pull out patterns, we wanna make conclusions. We want to find the picture in the information. It isn't always there.

Greg Potter - 33:07: Sure. I wonder about the small amounts of neurotransmitter precursors, the supplement companies include in their products and whether that's meaningful within the context of a diet which contains an abundance of the amino acids anyway. One thing I wanted to ask you about quickly is whether you found creativity training effect REM sleep? The reason being that REM dream's thoughts provide a safe environment in which to form new associations between things. Your muscles are paralyzed, you have a very safe neurochemical environment too, so you can collide all these different sources of information to form new associative networks. Does the type of training that you use for creativity specifically increase the salience or the vividness of dreams?

Andrew Hill - 33:50: Now, I've seen it ramping up plasticity increasing vividness of dreams. I will say that a lot of the creativity protocols, which are in the class we call alpha theta protocol will actually degrade the depth or the quality of sleep, in that they make it harder to fall asleep, so it's doing something in the sleep architecture. We have to watch that sometimes and adjust around it and improve sleep other ways while we're doing alpha theta. It's doing something to sleep, but I haven't studied it in an exhaustive way. I haven't done sleep studies look at the change in REM and the data, and I'm only getting coarse reports back from people about what they're experiencing, so there's something going on in creativity work that is changing sleep a little bit.

34:24: It's an obvious effect, but it's not a massive effect. I often work around it, again, because unless I'm careful I can erode sleep architecture a little bit by doing too much creativity work.

Greg Potter - 34:35: Interesting. I suppose that neurofeedback's a form of endogenous neurostimulation, so you're self-manipulating neural activation and that's resulting in enduring changes in your biology and your behavior. To me, that's very appealing. What I'm wondering is what do you see the advantages of neurofeedback being versus other ways of enhancing brain performance, whether that be nootropics or whatever?

Andrew Hill - 34:58: I think that you have to think about fixing resource limits, plugging holes, so to speak, in your day-to-day performance, but also you have to think about the trajectory of change across the arc of a project or the arc of your career, or the arc of your life course. There's things that you can do that will support flat trajectories that decline late in life. Meditation has some immediate benefits. If you meditate 10, 20 minutes a day you will have more benefits in executive function, in sleep regulation, in mood regulation, all kinds of things. What you'll also do is you'll side step normal cortical thinning that occurs with age and you won't have a slow down in your alpha speed.

35:32: You can think about laying in a multi-prong strategy where some of these things are lifestyle habits that are what I call modifiable behaviors, things you can do to minimize the likelihood of dropping that trajectory and maximize flattening or even raising the trajectory and that includes doing lots of these bio-hack things. If you're somebody who's got a lot of cholerigenic issues or some risk of memory problems or actual memory problems and now you're supplementing with citicoline and piracetam and other nootropics that's great, you're flattening trajectories. True nootropics are neuro protective and good for long-term support. Flash-in-the-pan or marketing-driven nootropics, things that aren't truly nootropics like modafinil and other psycho stimulants don't fit this rule, but generally the nootropics would support long-term health, as well as better performance in the short term.

36:16: I like nootropics as a way of plugging gaps in day-to-day performance, palliatively almost, as well as giving you some protection against long-term drops. Then we have strategies that are voluntary like mindfulness and meditation, which does the same thing, produces short-term gains and long-term protection, and neurofeedback, which is involuntary and is a massive resource builder. The way that I approach it really is to go in and make the biggest shifts in a very short amount of time, relatively speaking, with neurofeedback. Less than a year you have a dramatically different brain. If you crank hard, in a few months you have a dramatically different brain, but then you may have lots of other skills and human resources to fine tune. I think that happens a lot of the time if you go after the resources first, the use of those resources will sort itself out.

37:00: The metaphor I use, "I took you out of a VW Bug and put you in a Tesla, you're driving would change." Sooner or later you would be leaning into those new resources. I'm a big fan of going after the core stuff with aggressive things like neurofeedback, building a long-term strategy to support everything voluntarily using mindfulness, going after specific things with nootropics, either specific risk factors or bringing up performance if you're a high performing individual and you need to scaffold that here and there, and then identifying problems in sleep, nutrition, etc. Those are the foundations, so those end up becoming the things you just start with. I think it's all part of a picture and you can optimize most of these things pretty well and get massive shifts in your performance and short terms.

Greg Potter - 37:42: Neurofeedback amplifies the beneficial effects of other things. Mindfulness is something that somebody can do without a practitioner to help sustain those benefits and then you can plug in the holes with things like nootropics, as well as directly targeting specific things within someone's lifestyle, be that diet or sleep, and that provides the overall framework from which someone can improve their mental fitness.

Andrew Hill - 38:04: Exactly, and quantifying it, measuring your sleep, measuring your tension performance, measuring your stress response or at least recording how you feel subjectively and getting a sense of the day-to-day variability and where that sweet spot in stress versus disengagement is for you and building life scaffolding to keep you operating well and keep building all these things in, healthy habits, stress management, sleep management, diet management, exercise, etc., every day if you can. All these things become lifestyle things versus massive interventions over time.

Greg Potter - 38:34: Finally, I'm interested in your thoughts on the future. We now have studies of human brain machine interfaces that have shown that paralyzes people, for instance, could learn to operate external devices and that's based on what's going on in the primary motor cortex, as recorded by electrodes. What do you think some valuable applications of neurofeedback will be going forward and where do you see things in a few years' time?

Andrew Hill - 38:57: BCI, brain computer interface, that you're describing and neurofeedback are essentially the same computer-human loop, but run in the opposite direction from each other. In BCI, changes in the brain control the environment, like you're writing a letter looking at letter spelling or you're turning lights on and off in the house, or the right thing happens the brain notices it and you get an evoke potential. The computer grades that evoke potential as a control signal and the environment is controlled. It's a very coarse set of controls. It's binary often and we aren't yet able to measure the EEG and get thought out of it, so you're getting very coarse, up, down, on, off control of the environment.

39:31: The other direction, if the environment only changes, games only play or music only happens, when the brain does certain things then the environment is shaping or pulling the brain in a certain direction. So, I think these two fields are colliding currently and that's having the effect of bringing down cost dramatically to neurofeedback gear, which has always been a bit niche and very expensive compared to what it should be, in consumer tech anyways. It's also bringing up the technical ability. I think that things like the QEG databases they're really wonderful products and a lot of profoundly skilled and high-level work went into creating them, but they are just that, they are products. They are siloed bits of information owned by proprietary companies.

40:07: The paper I mentioned, the [Johnstone 00:40:09] paper we'll use numbers like hundreds to a thousand or so people. Now the databases are much bigger, I think the larger ones have four to five thousand people in them at this point, and so they're still good products, but we need databases of 100,000 people's data, so we can start really getting a sense of the variability across humans and how these things work. I foresee a time in a few years, I don't go quite as far [inaudible 00:40:30], but I would go as far as saying we should have a much better index of our moment-to-moment brain performance and health like we do in our smartphone that's looking at like the steps we took that day or other quantified self things.

40:42: It'll also be tracking fatigue states, and classifiers in the EEG telling us if we're actually safe to get in the car and drive when we're tired, when we're drunk, or it will tell us that a spot anxiety marker is showing up and suggest some tuning, or maybe it'll kick in like a pacemaker does when your heartbeat drops too low or you get some v tach or something it changes the rhythm. We already have pacemakers in the brain, DBS for Parkinson and things and for depression, so I think we'll get to a point where the line will get a little blurry, but we'll be able to reach in and both cosmetically, as well as for medical and psychological reasons reach in and change the brain a lot more discreetly. I think the very near future, the next 5 or 10 years, that'll happen and we'll end up largely eliminating what I consider the bulk of psychiatric psychology, medicating anxiety, sleep, depression, ADHD, seizures, migraines.

41:29: I think all of those things are regulatory failures that can be tuned away pretty easily in even the coarse understanding we have now. Soon, we'll have much better understanding and better tools and we'll be able to per person very quickly get rid of problems and bring up resources that they want to. Essentially we do now, but faster, cheaper, more reliably, and more a part of our everyday attack that should happen. There's no reason not to make control of your own brain health be something you do the same way you walk into a gym or a yoga studio three times a week and work out.

Greg Potter - 42:00: It's an exciting time. I hope you're right. Finally, is peakbraininstitute.com the best place for people to get in touch? Is there a question that I haven't asked that I should have asked?

Andrew Hill - 42:12: Peakbraininstitute.com is a great place to get in touch or Peak Brain LA on Twitter and Instagram. It's all the same company regardless of all of our locations. The only question you may have wanted to ask is what can people do themselves if they can't do neurofeedback because the gear, unfortunately, is a few grand in U.S. dollars and then it often takes some skill to use it. The only thing I would point people back to is meditation or doing biofeedback. Biofeedback on the peripheral system doesn't take a lot of high tech. I'm a big fan of HRV, heart rate variability, as an entrée into good biofeedback. It will do a lot of things that meditation will do and some of the things that neurofeedback will do because you're really acting on the vagus nerve, which connects the gut, heart, and the brain, when doing HRV biofeedback.

42:51: I would say that's a missing detail of actionable lower cost and tell people to jump on an HRV training program because it's powerfully effective and much more accessible in terms of cost than is neurofeedback. Of course, we're happy to get you set up with neurofeedback, too, if you need.

Greg Potter - 43:05: Andrew, it's been great to speak to you. Thanks so much for your time.

Andrew Hill - 43:08: My pleasure, sir. Nice to speak to you. Talk to you soon.

Kendall Kendrick - 43:12: Thanks for listening, and come visit us soon [humanos.me 00:43:15].