12 April 2018

Brain Training with a Neurofeedback Machine


My good friend Dr Rory McGill is a holistic doctor based in Plymouth UK, focused on improving health without the use of drugs. When I found out that he owns a neurofeedback machine (NFB) to conduct neurotherapy for his patients I had to ask him some questions and give it a go for myself!

Dr Rory McGill placed a rubber frame over my head, a way of holding the sensors in place. There was a ground sensor on each ear, with a positive lead on my crown (halfway between my ears and halfway from the front to back of my head) and a negative lead connected to my ear. He had 2 computer screens which showed my EEG being shown, the electrical recording of my brainwaves.



Dr Rory McGill:
I'm going to set the frequencies of the electricity, the electrical waves, a little bit below where you are now. I'm going train down your fast waves. If you've got too much fast wave you tend to be a bit over-aroused. If you've got too much slow wave you are perhaps a little bit spaced out. So that's a very simple ... an over simple way of putting it, but that's what we're going to do.

Lester Savage:
So you’re taking readings of the electricity that's coming from my brain, but are you also electrifying my brain at the same time?

Dr Rory McGill:          
No, there's nothing going in. We're getting a recording from it and we're using that recording to give you feedback on what's going on in your brain. When you get to where I want you to be, then music will play from my computer. And when you're not there, it won't. Your brain will get to learn something about what's happening inside it, and it can learn how to correct itself.

Lester Savage:
This is really interesting.

Dr Rory McGill:
Even without you deliberately doing anything, and especially without you deliberately doing anything, your brain is learning how to get that music to play. In a proper patient I could set those levels according to your problem or according to your overall EEG and you'd be getting some useful feedback.

Lester Savage:
So is this just showing that I'm a psychopath? Is that what it's saying?

Dr Rory McGill:
I hate to say that, but yeah. No, I’m joking! Actually, you’d need to do a map of the whole brain to get a better diagnosis, and you can't diagnose psychopathy like that. So normally I would have you with your eyes closed, and you can meditate, you can almost do what you like with your thinking, but your object is to get the music to play. And you can't do it with effort, you just have to sort of let it happen.

That is neurofeedback. I can do different sites on the surface of your head, which come from different parts of the brain, and I can train different frequencies, depending on what my object is. Is my object to get you thinking more clearly? Is it to treat a specific condition? What am I trying to do? But it's purely recording. We're not putting anything into your brain. Just say that over and over, because people do get a bit concerned, because it looks as if we might be about to give you an electric shock.

Lester Savage:
Let's say someone comes in, they sit in this chair and they're extremely anxious. Hypothetically, they get some really quick waves going on. Will they have high levels of electricity or just high frequency?

Dr Rory McGill:
High frequencies, yeah. The amplitude is something different. The amplitude is the height of that wave. The frequency is obviously the speed of that. Amplitude, you get a lot more ... When you're younger there's a lot more amplitude. If you have a condition, either just getting older or anything that involves shrinkage of your brain, the amplitude is smaller. If there's some eating disorders and some malnourishment in general it will also shrink the overall white matter, and so the amplitude will be smaller. But we're really focusing more on the frequency with neurofeedback.

Lester Savage:
Just to clarify, I'm learning how to train my brain completely on a subconscious level.

Dr Rory McGill:          
Yeah. Sure.

Lester Savage:
Normally it's very hard to do that, unless I guess we're in a deep state of meditation. It's hard to consciously become aware of a subconscious process, isn't it?

Dr Rory McGill:          
Yes.

Lester Savage:
So you're saying that when my brain is doing something you want it to do, music is playing. And that subconsciously is going in, which means that my brain, because it wants to hear more of that music, sends electricity through the same neural pathways or just tries to slow down?

Dr Rory McGill:          
Yeah, exactly. That's what it's doing. It knows that you want the music to play, so it's gradually changing its own frequency. A good example is a toddler who is learning to walk. There's not a lot of thinking going on there, but the toddler falls over. And that's a toddler's feedback. They just try, and try, and try, and try again, and each time they get feedback, the brain is learning to do something different into the body. But the toddler, as far as we know, is not deliberately thinking about that. They're not deliberately putting their legs in different places, they're just trying again.

There’s also the example of learning to play darts. The first time you ever go to the dartboard, having never thrown a dart before, you stand on the line and you throw your dart. 20 years later, when you're the world champion, you do exactly the same. You stand on the line and you throw the dart, but in those 20 years just doing the same thing over and over and over again, your brain has learned unconsciously how to get your arm to move so that the dart goes in the right place. You don't really know how you've done that.

That’s what’s going on here. Your brain changes itself. This is true of all kinds of biofeedback. If I wanted to, there's a module on this machinery where I can attach something to my fingers and learn to make my fingers warmer. And what that does, is it effects the nerves that effect the blood vessels to my hands and fingers and teaches them to be able to open up the blood vessels to my fingers. I could possibly do that if I just relaxed and imagined, but it's a lot more effective and quicker if you use biofeedback.

Lester Savage:
Wow.

Dr Rory McGill:          
Yeah!

Lester Savage:
So you can completely train your brain with this... I mean, in theory, could you train someone to have higher levels of anxiety?

Dr Rory McGill:          
Yeah, definitely!

Lester Savage:
A doctor who can make you have panic attacks, an extraordinary service!

Dr Rory McGill:          
Yeah, it would be no problem.

Lester Savage:
It’s nice to be able to enter a blissful state, but you don't want to be able to have that all the time. There's actually a varied level of sense that we want to be at.

Dr Rory McGill:          
Yes, it is nice to have access to all kinds of states. They're all useful. To have fast waves is really useful when you're doing something that involves quick thinking and quick decision-making. It's also useful to have access to slow states. Clearly, you won't be surprised to know that when you're asleep you get quite a lot of slow stuff. And in childhood, most of the time your brain is in slow wave states, which is why children are programmable, if you like. Children are learning very fast. I think that's partly why they're in slow wave states, and also why they're very good at make-believe. They'll play trains and it's almost as if they feel that they're on the train. Their play is reality.

Lester Savage:
Wow.

Dr Rory McGill:
If you put a child on here you will see a different pattern. Children are not just small adults as far as the brain is concerned. They're getting a lot of slow waves. That's normal.

Lester Savage:
Okay. And would I be right in saying ADD or ADHD also have quite a slow wave pattern?

Dr Rory McGill:          
Yeah. If you look at the work of Dr Daniel Amen he has found this in his research, and he uses a lot of EEG and lot of SPECT scans, he says there was seven different varieties which have a different EEG pattern. But certainly, the commonest of those, classic ADD, does have slow wave in the frontal lobes.

What would normally happen if I ask you to do a mental problem, to give you some arithmetic to do, is you will get a bit of speeding up. But instead, with ADHD, you get some slowing down. And of course, when that happens, instead of focusing on the problem you kind of stare off into space for a while, you're not even thinking about the problem. I've certainly seen people doing that, when you give them a problem, instead of thinking about it, they just sort of stare off into space.

Lester Savage:
Like daydreaming.

Dr Rory McGill:          
Which is why the conventional treatment of using amphetamine derivatives to speed things up works, even though it seems a ridiculous thing to do to someone who can't sit still.

Lester Savage:
So that's the reason someone would be prescribed something like an amphetamine, is to actually speed up the frequency of their EEG and increase concentration span?

Dr Rory McGill:          
Yeah, because actually it gives them extra control, because they're not spacing out so much. Certainly at least one of the other seven types that Doctor Amen points out, if you want to give them amphetamine-like derivatives, this would not be a good thing, because their EEG is totally different. So that does demonstrate the advantage of having some kind of measurement of the brain before you go administering drugs if that's what you do.

Lester Savage:
Right! I do talk about Doctor Daniel Amen in my book Becoming Biochemically Sober in regards to measuring identity. I think it was actually you who introduced him to me, because we seem to be diagnosing people with certain mental health disorders without testing the organ. Can you just remind me what a SPECT scan is? I think Doctor Amen has seen about 125 thousand of them.

Dr Rory McGill:          
Yeah, sure. The difference between a SPECT scan and a normal, say, straightforward MRI or CT scan, is that a SPECT scan is functional, it tells you about activity. You can have a scan like a CT scan, which just shows you anatomy, showing you structural problems. Or you can get a functional brain scan like a SPECT scan, a functional MRI which shows you activity and what is actually happening in there. One is of anatomy and one of physiology. You will get useful information but different information from both. An EEG again gives you physiology, it tells you what's happening, not just structure.

I think only in relatively recent times have we been able to get information from functional brain scans about what's going on inside. The only thing, I think, that's blocking that from becoming more widely used is the expense. I don't know how much a SPECT scan is, but it's certainly expensive. Because the machines are very expensive so many hospitals will not have them, and they're certainly not available for use all the time.

Half the pharmaceutical companies haven't decided yet whether they're a good thing or not, as to whether they're going to support prescribing or not. Ironically, I think they often do if you are going to prescribe drugs, not just for ADD. For information about what's going on can actually be helpful in choosing what drugs you might use.

Lester Savage:
Yeah.

Dr Rory McGill:
I think potentially we'll probably see more functional scanning and so maybe Doctor Amen's vision of a world where anybody who's got a mental health problem has some kind of functional brain measurement before they're treated. Maybe we will see that.

Lester Savage:
What would you normally do for a client who might be suffering from, well, any mental health disorder compared to someone who just wants to optimise their control of mental states?

Dr Rory McGill:          
I think general is what I use it most for, because I'm a clinician. I mainly see people who've got a mental health problem, ADD being the common, but also any anxiety disorder. I've got some experience in one patient with an eating disorder. Probably anxiety, would be the biggest number, but as you said just now, there is also potential use for anybody to optimise brain function. I haven't done much in the area of head injury, although I've had head injuries myself and this is partly the reason why I sometimes put myself on there. Partly because I want to optimise my own brain function, especially as I get older, and partly because I have had a few head injuries in my time and my brain doesn't work quite as it did before.

Lester Savage:
It's very fascinating. Is there a particular state that's related to the flow state? Where someone is completely present and is completely focused on one thing, everything else disappears. A lot of surfers and musicians, they refer to this state as flow.

Dr Rory McGill:          
I'm sure there is, I couldn't tell you what it is, and I've done a lot of work in that area. But I'm absolutely sure that exists, and that if you look at Dave Asprey that's the kind of thing he's looking for. I'm sure that's trainable, and it would be partly a well-known kind of bunch of frequencies but partly individual. Then say if I was working with you, the machine would be individualised and adjusted to make it just where you want it to be. Maybe not making it exactly the same for everyone else. That's the advantage of this, is that it can be individualised. People can be quite different, if you just go in and do the standard frequency every time you will get some surprises sometimes.

Lester Savage:
Surprises in what way?

Dr Rory McGill:          
You might think that the frequency you're using is a slower sort of state, but actually for these people, because of, usually, childhood emotional trauma, they need to go a whole lot slower. You've just got to always watch, both within the sessions and between the sessions. Not just what's going on on the screen but what is happening to this person.

Each session, if you're in the right place, at the very least, the person shouldn't feel worse. Hopefully slightly better during and just after the session, and cumulatively as you go along. You do actually want this person to feel better, and if they're not, you think, even though that seems like quite a slow frequency, if they're getting agitated after, you may need to go slower again.

I still think of myself as very much a person with L plates on when it comes to neurofeedback. It's a complex subject and it takes a while to learn, and I'm learning, but I always make sure to stay within my bounds of experience. I have a useful mentor that I use when I get a bit stuck, but as long as I pay attention to this person sat in that chair, I'm usually okay, because you can tell as you go along, how's this person looking? If they've got their eyes closed, they might not be saying anything, but you can pick up from just body language, from the physiology of what's happening, do I need to alter this training?

Lester Savage:
That's really, really interesting, that whole concept. How many sessions or how long would it take to see a difference in someone? I don't know if it's the placebo, but I already feel better now.

Dr Rory McGill:          
I think there's some evidence from a lady called Sebern Fisher who has done neurofeedback for a lot of years. Sometimes just the act of giving the brain some feedback, even if, as today, really, that's random, just the brain having some feedback and having to change itself, it's a bit like going into the gym without a personal trainer and just doing some exercise… it will benefit you even if it is not targeted to your particular problem. Maybe sort of like that. But there will also be placebo effect and the fact that the music is very nice. And we know each other quite well, so we quite like chatting together, the subject's interesting, you may feel better, so there's all those kinds of things going on. As to how many sessions, if you've got a good, healthy brain you can see changes within just a few sessions. If you've got childhood trauma, for instance, you might be ending up with more than a hundred sessions.

Lester Savage:
Wow.

Dr Rory McGill:          
I've not got anybody who's reached a hundred yet, but I've certainly got people up into the seventies, perhaps coming once a week, because it is the total dose that probably matters. You can go on a week away somewhere and have neurofeedback twice a day, so you can have 10 sessions in a week. Whereas if you only come once a week, it takes 10 weeks. It is the cumulative dose of training that matters. What I'm doing is sort of bespoke neurofeedback, tailoring it very specifically within and between sessions, to your brain.

You can now get more off-the-shelf neurofeedback equipment. They'll cost a couple hundred quid maybe. You can just buy it and do your own neurofeedback at home every night, and get a generic kind of, off-the-shelf, kind of train your brain to be more relaxed and more in tune, if you like. That's available now, I think it's very good. But if you've got a mental health problem you're probably better off getting a bespoke person, somebody who knows what they're doing. But if you just generally want to feel better and get your brain tuned up, buy something like the InteraXon Muse

Lester Savage:
What stage is it that we're in when we're sleeping? Is it delta?

Dr Rory McGill:          
Delta is deep sleep. Theta is more likely to be REM sleep, so the more active kind of sleep. Again, not an expert in that, never done an EEG personally when people have been sleeping, they're always awake when they're here. But yeah, you do go into slow wave sleep, that's what you want, and you'll see that, I think, in a sleep laboratory.

I tell a lie, actually. People do occasionally fall asleep while they're in that chair. Say if they come at five o'clock in the evening after they've been at work all day, they sit down in the chair, they close their eyes ... and they get some nice music playing. I'm training their brain down, not surprisingly, sometimes they do fall asleep. As I'm trying to release the slow wave and actually it's going up, I think "Hang on a minute, they've gone to sleep." I say "You all right?", they say "Yeah, yeah, I'm fine." then we get it back again. So yes, that's what your sleep is.

Lester Savage:
Right, so will you be talking to patients like we're talking now or will you leave them alone to just allow their brains to run?

Dr Rory McGill:          
Mostly I leave them alone, particularly the ones who are experienced, especially if they're experienced meditators. Quite often what I will do is just give them kind of five minute points. I'll say "Right, that's five minutes, that's ten minutes", then know how many minutes they're doing. Otherwise they get involved in thinking "Crikey, how long have I been doing this? Feels like it should be 30 minutes", or something. So giving patients an idea of where they are often makes them feel a bit better. I'm happy if people want to speak to me, if there's something they want to say, and they can have a drink of water, or something, but mostly they stay quiet.

Lester Savage:
Yeah.

Dr Rory McGill:
There is a visual side as well, and that can be used. I can't actually demonstrate it on this particular screen because it's not working at the moment, but if you've got a person, particularly a child with ADD, you can train with effectively a computer game. So I'm playing the computer game with my mind, effectively, and say if it's a car going along a track, when I get into the zone where my therapist wants me to be, the car will move, and it will go faster depending on how well I'm doing. If I kind of go off into space somewhere in my head, the car will stop. Children do like playing computer games with their brains, it's an attractive idea.

Lester Savage:
It's an attractive idea to me!

Dr Rory McGill:          
As I say, it should be.

Lester Savage:
My next question was going to be, theoretically could someone wear this when they're sleeping, and you could put the certain levels that you wanted, and they would subconsciously, as they're sleeping, train themselves to have better sleep?

Dr Rory McGill:          
Yeah. I don't know if that's been used. I do know it is possible to influence people while they're asleep. There is some evidence, I think, that you can actually talk to people while they're asleep and it will have an effect when they wake up. I'm sure that you could do neurofeedback while people are sleeping.

Lester Savage:
I guess that would be a very fascinating thing to study further, wouldn't it?

Dr Rory McGill:          
Yeah, I think so.

Lester Savage:
If people could, even when they're sleeping, be training their brains to have better sleep.

Dr Rory McGill:          
Yeah.

Lester Savage:
You said it's actually the cumulative dose that matters. Could you technically just wear it all day, every day?

Dr Rory McGill:          
That's a good question! Again, I don't know if anybody's done that, or what period of time. I don't think it's necessarily for any breaks, but it's just in practical terms. In practical terms you've got to have breaks because you've got to go to work, you've got to live your life. But I suppose what you're saying is could you even have a very simple version attached and walk around your life? I am sure if it's not already available, then yes. It seems likely that you will be able to do that.

Lester Savage:
I think the most interesting point out of all of this though, that I think is also really important to clarify, is that actually everyone is different. There isn't just one way to do this. The best state for yourself in certain situations, even on a neurological level, may be, most likely, very different from mine. But also that actually there isn't just one state that we want to or should harness.

Dr Rory McGill:          
Exactly that, yeah.

Lester Savage:
It's good to be able to train multiple different states that at least empower us. I think for a lot of people it would be nice to feel absolute bliss all the time. But it's not the most practical. I think it's good to have a variety as well.

Dr Rory McGill:          
We both enjoy cold swimming. We know that actually getting used to being very cold, getting used to being very hot, and having access to the ability to have all states in between is a good thing, and in the modern western world, of course, people can control their environment to such an extent that that never happens. They're either in air-conditioned rooms, or they're in a heated room, and the temperatures can be very closely controlled, and that is definitely going to weaken you.
The ability to have access to both ends of the spectrum, the sympathetic and the parasympathetic, to be able to be completely still, and to be able to go flat out, it's across the board, through the human body, this ability to explore the whole range. I think it's an important theme to come back to over and over.

Lester Savage:
Absolutely, truly fascinating! Well thank you ever so much for letting me try this equipment, it's brilliant. Can you talk me through what’s showing on your screen?

Dr Rory McGill:          
This here is what's known as the raw EEG. That's the basic EEG and the clever machine separates that raw EEG out into what I've selected, which is the fast stuff, and the slow stuff. Both those things are in there.

Lester Savage:
I had no idea you could actually be experiencing two states simultaneously. Well, probably more than two states...

Dr Rory McGill:          
There's two kinds of electrical activity going on, more than two. Yeah, there's a whole load of electric activity going on at the same time. This is the cleverness of modern machinery, that it can spot those things in there, and don't ask me how it does that!

Lester Savage:
One of the things that the resonant rate breathing does is to increase heart rate variability.

Dr Rory McGill:
Yes it would. With this machinery we could do heart rate variability on it also.

Lester Savage:
Really?

Dr Rory McGill:          
Yeah, this same machinery you can do heart rate variability on that. We want your heart rate to be constantly varying. So what's important to distinguish is if I feel the pulse, my pulse is regular, I'm glad to say. So, an irregular pulse, like that one you just did, that's generally what's known as atrial fibrillation, which is not a good thing, that's an irregular pulse.

What we're talking about is even though this feels regular, there is some variation to it, and so I'll take my pulse and I might say, if I count it for a minute, I might say my pulse rate is 54 times a minute. 
But if I'm continuously monitoring that digitally on a screen, I will see that that's going up and down, the speed is varying, it might go 54, 55, 56, 53, 52. If you plot that on a graph you'll see coherence if I'm in a good state, and you'll see a nice sine wave. That's optimum kind of heart rate variability.

Lester Savage:
So you would attach another lead to that?

Dr Rory McGill:          
I would attach a couple of leads to your chest and that would record heart rate variability.

Lester Savage:
Wow, so you can actually do it all simultaneously?

Dr Rory McGill:          
With the biofeedback you can't do it simultaneously, you need to do one at a time. Because you will confuse your system, and this machine wouldn't do it anyway. You'd have to take these wires out and put another one in to record heart rate variability and do that as a separate thing. I'm sure that machinery exists to do it at the same time though, I'm just not sure whether that would work.

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