Dr. Heather Davidson: Neurofeedback & Virtual Reality Alternatives to Medication

Hey, Andrea. Hey, Emie. I'm so excited for our guests today. Thank you for Finding this incredible woman, Dr. Heather Davidson. Tell us a little bit more about Dr. Davidson. So Heather Davidson is a New York State licensed psychologist with a specialization in child and adolescent treatments and board certified in neurofeedback, biofeedback, and virtual reality.

Her main areas of clinical expertise include ADHD, oppositional defiance disorder, anxiety, and OCD. She is extensively trained in neuropsychological assessment and utilizes a unique approach by combining traditional psychological testing measures with QEEG, which is actually a non invasive brain scan.

And although she specializes in child psychology, she works with patients of all ages. And again, she works with biofeedback, neurofeedback, and virtual reality therapy. She is going to be extremely [00:01:00] interesting, I think. I cannot wait. Heather, thank you so much for joining us today. We are so excited to have you on.

Emmy and I were just laughing because we're going to be picking your brain probably more than you're comfortable with because we're so excited to hear about what you do on a day to day basis. Yeah. I'm so happy to be here. Thank you for having me on. Yeah. So what we'd really like to do is, um, if you can just give us a little bit of your background and then we'll get into kind of the nuts and bolts of what you do and pick your brain about some of your practices that you do every day.

Sure. Yeah. So I am a child clinical psychologist, so I specialize in working with children, adolescents, families, parent management training. I also am board certified in neurotherapy or neurofeedback. So I do a lot of brain wave training. That was a secondary kind of board certification for myself. I do biofeedback, neurofeedback, virtual reality, exposure therapy.

So I specialize in a lot of just the, the technological interventions. So, you [00:02:00] know, I actually got my degree out in Los Angeles and was matched for my residency or internship program in New York. Plan to only be there for about a year to do, you know, my internship and then ended up staying there. Uh, you know, it's been like 10 years at this point, so it's wonderful being in New York.

Uh, my practice is there. I have a private group practice where, you know, I, I run a children's center with the other members of the group practice, and I also am in charge of all of the technological interventions for all of the kids that come through as well. Wow, Andrea, I'm totally geeking out. I don't even know where to start.

Everything she says is like, ah, ah, ah. I know. So you really focus more or less on therapies that are outside of medication, or do they run kind of side by side? And how did you determine when you're with a patient what therapies that you're going to use? Or yeah, yeah. So usually how it is that I describe it is a medication as a last resort.

So I'm not anti [00:03:00] medication. I think medication has its place. I think it can be very helpful. I think it can be life saving, honestly. So I'm not someone that's going to sit here and say, don't go on medication. Medication is awful. Um, I think, like I said, medication can be extremely helpful. But I do take a medication as last resort approach, which just means I'm looking to see are there any other options or interventions that we can do first in order to see symptom improvement or in order to treat whatever, you know, symptoms we're looking at.

So for example, you know, if I'm looking at someone that has anxiety, I'm not going to say, okay, let's get you on some anxiety medication, some benzodiazepines or some SSRIs. First, I'm going to say, let's try some cognitive behavioral therapy, just because that's empirically supported. That's what I have, you know, the most experience in, and that's what I've seen be very effective.

For anxiety, but I'm also going to say let's add in some biofeedback because that's also been empirically supported and shown really wonderful results for anxiety [00:04:00] in the research, but also just what I've seen myself in person with a lot of my patients. is it's one of the only interventions that you can see almost immediate symptom reduction.

So I'm looking at, okay, CBT in combination with biofeedback. And if there's anything else, you know, I need to do, I will recommend that and go through that. If all else is failing, or the anxiety is so intense that You know, the patient is unable to function, right, like go to work, then at that point, I'm going to suggest some higher level of care, maybe like a partial program, a hospitalization stay, or, you know, medication at that point.

So biofeedback and CBT work that quickly, even for anxiety? Yes, yeah. So biofeedback, I've never seen something work so quickly, particularly with panic disorder. Wow. A lot of times I've had, you know, kids, adolescents. I do see adults as well because I do specialize in these technological interventions, and I've never seen anything happen so quickly where usually within, you [00:05:00] know, 123 sessions of biofeedback.

I have patients reporting kind of like an immediate reduction in panic. Panic a lot of times is spurred by panic. So once you kind of take away the power of the panic by giving an intervention that is shown to work and we can see on the screen if it's working, then patients a lot of time just stop panicking.

Can you explain real quickly, I know both Emi and I know what biofeedback is, but can you explain what biofeedback is and how it works? Yeah, good question. For a patient? Yeah, yeah. Absolutely. So biofeedback is it's an active means of feedback from your physical self. So in my office, what it is that it looks like is I get you hooked up with with three different kind of monitors.

One is a heart rate monitor so that I hook on to your finger and I'm able to see what's going on with your heart rate. The next one is a respiration band. And so that's picking up on on your breathing rate and that's attached around your stomach. The [00:06:00] next one is something called a galvanic skin response or GSR.

And that is looking to see what is your stress level. It basically takes the electrical currents that are going on under your skin and. It transforms that into a number. The higher the number, the more stressed that you are. So I've got these three things that I'm looking at on the screen. And then the biofeedback is taking control of those three things by breathing a very specific way.

All of my patients that come in and a lot of my trainees, they're always just like, Oh, okay, so, you know, yoga breathing. And it's like, Oh, well, you know, yes, yoga breathing is great. However, this is a bit different because we're looking at what research indicates. to be the most effective in turning off your fight or flight system by breathing at six breaths per minute.

And that's actually a lot harder than people think that it is. So I've got my pacer on the screen that shows me when you're inhaling and then when you're exhaling and then I can kind of coach you, okay, we need to do, you know, the breath with your stomach. You really need to feel the air coming into it.

[00:07:00] We need to make sure that it's actually more of a smooth transition instead of an abrupt one. And it looks like you're breathing at 5. 5 breaths. per minute instead of six. So we're not quite getting into what we call heart rate variability. Heart rate variability is what we want to achieve, and that's when there is a good amount of variability between your lowest heartbeat and your highest heartbeat.

So when you're inhaling, your heart rate is going up, and when you're exhaling, your heart rate is going down. We want about 30 beats to be in between the highest and lowest because that gets us into something called heart rate variability and heart rate variability. is what turns off your fight or flight.

You cannot panic. It is physically impossible. You can still experience cognitive anxiety, but the physical anxiety symptoms are impossible to experience when you are in that state. So really, the patient is taking control of their own bodily reactions to whatever that anxiety is [00:08:00] having. So they're, they're I would think that not only are they managing their physical symptoms, but also because they've got that control, they probably psychologically are feeling calmer too because they've got their feeling like they're in control.

Is that right? Yeah, that's exactly right. So it's not just the active act of biofeedback, which does reduce anxiety and panic, it turns off that fight or flight, but it's just even the belief that like, Oh, I've got something that I can do that will turn it off. It actually prevents the panic from happening to begin with, because what creates panic and sustains it and maintains it is this idea that like, I'm out of control.

The panic could happen at any moment and I can't do anything about it. Well, once you take that, that power away and you say, actually, I can turn it off completely. Then a lot of times people just stop panicking to begin with, stop experiencing that anxiety to begin with because they know they can stop it.

That's a huge tool to have in your tool belt. I know you can do that. Can you explain how the [00:09:00] physical act of breathing informs those, those data points that you're tracking through the biofeedback? Like what's really happening? Yeah. So the breathing is actually just changing your heart rate. What we find to be most important is the heart rate.

So the breathing, it's not actually anything important in the sense that how it is that you're breathing only just impacts your heart rate. So for the heart rate, what is creating that, that kind of switch where it's turning off that part of your brain that controls you know, fight or flight. Like, okay, I need to panic because I'm in danger.

My heart rate needs to increase. I need to be, you know, have some adrenaline. I need to like be very much like paying attention, um, on edge. All of those happen whenever, you know, um, you sense something is wrong and then your heart rate starts to go quickly. When you start to hyperventilate like the breathing like that, it increases your heart rate and it makes it to where the variability in beats is not only [00:10:00] inconsistent, but it's just like very minimal.

Okay. And then that creates a very panicky state that creates like cold hands or, or sweaty, um, palms or just sweating in general. It creates that feeling of like dizziness and lightheadedness. Changes our blood pressure. Um, and so what we're trying to do actually is control the heart rate so that there is a nice variability between how it's beating.

Once we have that variability, like I said, at about 30 beats of a, of a difference, when you're inhaling and exhaling, so 30 beats of, of your heart rate, then that's kind of turning all of those functions off, but that's difficult. to achieve and the number one way that we know that we can achieve it is by breathing at six breaths per minute.

Six breaths is kind of the the gold standard, but every person is a bit different so it may vary a little bit. What age do you introduce biofeedback to? What's the youngest? Yeah, the youngest I've done is six. Okay. Any younger than that, you know, I don't, it kind of depends, right? So I [00:11:00] could technically do it younger.

Just depends on the cognitive emotional kind of level of the child with small Children though. We definitely don't expect six breasts per minute just because their little lungs are smaller, right? So we're actually going to, you know, do it a little bit higher, you know, at seven breast per minute, eight breast per minute, dependent on how young the child is.

Some kids though, I've had six year olds present as 10 year olds. I've had 12 year olds present as eight year olds. So I'm always assessing what the emotional and cognitive, you know, kind of abilities are. And then from there, I usually hook myself up first to show them like, Hey, look how cool this is. And then after I do that, I'm like, do you want to try it?

And I try and get that competitive edge of like, Ooh, let's do some breathing. And then I love to hype them up. So it's just like, wow, you are like the best I've ever seen. And kids just. You know, they eat that up. They love that. They want to be good at something. And so they want to keep doing it. And, you know, I try and make it fun.

I have like balloons in my office that I put on their belly so that they [00:12:00] can see it floating or I get stuffies and kind of add that in. But yeah, usually the youngest is, is about six. I could go a little bit younger, but that's usually the age that, that I stick with. And that's mainly for, um, anxiety and panic disorder, right?

You know, it's just where I see the fastest effects, but it's for pretty much anything. So biofeedback has long and short term effects. It's kind of like when you go to the gym, when you're working out, you have an immediate kind of hit of positive feelings and it feels good in that moment. But it also obviously has lasting effects on your mood and on, on your physical state.

And biofeedback is the same in the moment. It can stop anxiety, but research has actually shown too, that if you do biofeedback consistently, that it decreases anxiety, like general anxiety day to day. So it is both kind of in in that way. Can you do it at home? Is there anything that like people can do at home to like if you're sitting with your child and you know, you can't, [00:13:00] you can only get in to see you once a week.

Oh, yeah, no, that's, that's the goal. So the goal is I'm teaching you how to breathe, but usually, you know, let's say five to seven sessions of biofeedback, you've got it down, you know, it's kind of like the more you practice, the better you are at it, and you're able to do it anytime. But there is an app that I do recommend that will record your heart rate so that you can see if you are actively getting into heart rate variability at home.

Oh, so that's really great. And there's also just tons of different apps that you can download that have pacers that you can follow along. So it's not going to have, you know, that the screen for the biofeedback aspect, right? Where it's showing, Oh, uh, I can see that I'm actively getting into heart rate variability, but at least it is giving you the pacer so that you can reference something.

So I'll have patients do that. And there's ones for kids that are like flowers. And animals and then there's ones for adults. That's just like a regular pacer that shows like an inhale and exhale. Can you share what that [00:14:00] app is or is that a proprietary application? No, no. Yeah, sure. It's a paid for app. I believe it's six dollars.

It's called camera heart rate variability. Okay. And you know, it's a little tricky to find just because not many people, uh, are aware of it or aware of biofeedback. So it is down, like, uh, my patients are always like, it's not coming up. I'm like, you gotta scroll down. It's not top of the feed. For a couple ones.

Yeah, yeah. So you'll, you'll find it there. It is there. Uh, like I said, it is a paid for app. And then the only thing you have to do is just log in and make sure that it is set at six breaths per minute. But from there, it takes the camera. Where you can put your finger on it, and it's able to get your heart rate from that.

And then it gives you a pacer that you can follow along. Yeah, it's really great. It takes your heart rate from the camera.

Modern technology. I love that we opened with this conversation starting and starting to talk about the power of breathing. Because It seems like in the yoga world, everyone's [00:15:00] talking about breathing. Now there's that new book out called breathe or breath. And you see breath work on, I see that on my social media feed, people tattoo, just breathe to their arm.

So it seems like it's sort of this catch all phrase. And sometimes that can make it seem like it's watered down and less effective, but I love hearing from you professionally using this every day, advocating for the power of. Your own power to breathe and heal yourself. And I can't wait to tell my kids.

You said so. Yeah. Well, that's why I do, you know, whenever my patients come in and they're like, yeah, yeah. Rolling their eyes. I roll it right along with them. I was like, look, I am not the type of therapist. That's just going to be like, okay, we're going to sit here and do like. Some very severe, like mindfulness.

Uh, look, don't get me wrong, I love mindfulness. It's just I get where you're coming from. I get what you say about like, yes, yes, I understand breathing is important. Mm-Hmm, , but you're not actually understanding, right. The science behind it. And you're likely, you know, not doing it [00:16:00] at six breaths per minute, which is why you don't feel like you're getting the result that you want.

Everyone tells me I've tried breathing. I've tried meditation. I've tried all these things. And it's like, I'm, I, I'm sure that you have absolutely. And you probably did it to an extent where it did help a little bit, right? Because any type of mindfulness breathing is helpful. However, biofeedback is so quick to have an effect.

because you have to breathe a very specific way to get into heart rate variability. Just focusing on your breath doesn't get you into that state and therefore isn't going to have that powerful of an effect. Is there anything else we should know about how to accurately breathe to get that effect? The few things that I really go over in session, uh, is really just number one, breathing with your stomach instead of your chest.

And people find that when they're inhaling, they tend to like suck their stomach in, which is actually the opposite of what we want to do. So we want to almost imagine that we are inhaling a bunch of air and it's filling our stomach up. So our stomach is actually going out more. And then whenever [00:17:00] we are exhaling, we're taking all that air from our stomach and, and, you know, releasing it.

Another big thing is like how quickly people transition from an inhale to an exhale. So it's going to be very difficult to get to heart rate variability. If you're breathing, like that's a very quick transition as opposed to the, like very slow. And then you kind of wait a second and then exhale out. The other thing too is, you know, I tell people to try and do it with purse flips as opposed to just.

opening your mouth or breathing through your nose. You don't have much control over how much air is coming in or out. But with the pursed lips, you can really control how much air goes in and out. And the last thing I really focus on is try not to inhale quickly and then hold your breath for the remainder of that, that inhale.

pacer, if it's And then hold my breath, hold my breath, hold my breath, hold my breath, and then hold my breath, hold my breath. We want it to evenly distribute the breath where it's the[00:18:00] 

no holding at all. That makes sense. So that's what's going to create those smooth transitions. That's what's going to create good variability within your heart rate. Wow, thanks for sharing that. Andrea, are you just thinking about all the things you want to tell your kids now? Right. And myself, quite frankly.

I mean, I've, I've listened to, I don't know how many podcasts and read how many things on breathing, but it's, it's always just such a great reminder. Yeah. To that. You can really take control of your own actions and feelings by just slowing your breath and it just brings you to a different place. Now, the thing that actually caught me was you also do, um, neurofeedback.

And I would love to hear a little bit about neurofeedback, what it is, when you use it, how it's different than biofeedback and um, you just your take on it. Yeah, of course. So [00:19:00] neurofeedback is definitely one of those things that I feel is very intimidating for most people and clinicians alike. A lot of clinicians are like, it's hard.

It's not like biofeedback where there's, yes, there's this science, there's this physics, but it's, it still feels Like, okay, this is similar to the field of psychology. Neurofeedback is really, we're getting into reading EEG. We're looking at almost like a whole different field. So it is a little intimidating.

I know, you know, for me, whenever I first came upon it, I wanted nothing to do with it because I felt like, oh my gosh, this is, this is too much. As I, you know, kind of, okay, opened myself up to it, decided I'm going to go for it. I am going to learn this. It was incredible. The outcomes that that I saw from it.

So neurofeedback is basically brainwave training and how it changes from biofeedback. Biofeedback is active. You are actively doing something to create a physical change. Neurofeedback is passive in that your brain [00:20:00] is changing how it is that it emits different brainwave signals by means of operant conditioning.

Okay, so you are conditioning your brain to release different brain waves based upon reinforcing them. So it gets a little confusing when we talk about reinforcement because it's like, okay, well, how do I reinforce that? And usually what it is that I do is I first start off with something called a QEG, which is a brain map.

And I'm looking to see where there are problematic areas within your brain where there's too much of one frequency or too little of another frequency. Mm hmm. Once I do that brain map and I go over the results and I say, okay, for the neurofeedback protocol, we're going to focus on, let's say your, your alpha, which is a brainwave, your alpha production, your alpha production is actually really low, which is indicative of anxiety.

Or I may see, oh, there's a really big difference between your beta frequency and your theta frequency, which is very consistent in what ADHD usually looks like. So now let's [00:21:00] say you've got this this low alpha. I am going to create a protocol that will reinforce more alpha to be omitted from from your brain waves basically so that when there's more alpha it is going to then cause a decrease in behavioral and symptom presentation which usually when we've got low alpha we're going to see that as anxiety.

So now we're going to see less and less anxiety, or if I'm doing a protocol where I'm increasing beta, decreasing theta, or vice versa, that we are then seeing a symptom reduction in ADHD symptoms, executive functioning, uh, sustained attention, things like that. The way that I reinforce it in the moment is actually through a movie.

So you're watching a movie while you are hooked up, um, to, you know, a cap that is reading your brainwave signals. And every single time your brain is doing what I want it to do, the movie that you're watching gets bigger and the sound gets. And every single time that your brain does, you know, what I don't want it to do, then the movie gets smaller and the [00:22:00] sound gets lower.

So what do I do? Do I focus really hard or do I do? Nope. You literally just sit there and watch the movie and your brain does the work and it's completely passive for you. You do nothing. The only thing you can really do that helps is to sit still. Because it is an EEG, and so the more that you move, it just, it moves the wires around, which can create something called artifact.

But it's all non invasive, there's nothing that is going in, it's not like a shot, it's not invasive in any way whatsoever. It's just reading your brainwave signals like a classic EEG, it looks like a swimmer's cap. Uh, and then it's feeding it through an encoder, and then bringing those, those raw EEG signals onto my computer, and going through a software called NeuroGuide.

And then I can kind of, yeah, change what brainwave signals are being reinforced and which ones are not. Wow. So I, I thought you had to do something like think or like not think and be really still in your mind. You do nothing? No, nothing. It's really just focusing on the movie. [00:23:00] Okay. But it makes sense because the movie is the stimulus at that point when, when it's getting, you know, the things are getting big and you're, or louder, you're going to be responding to it just like you would in.

I mean, gosh, if you go to the movie theater and you watch Maverick, when the big planes come in, you know, you're excited, you can feel that, that energy come through based, versus, I guess, when you see something that's, I don't know, boring in a movie, you're, you're not, you're not stimulated. Yeah, I mean, it's not, it's not even so much the actual movie.

It's, it's mainly that it just gets annoying for the person that like, Oh, it's small. This I don't, I don't like this. I'm annoyed. And then when it gets bigger, it's like, okay, I'm engaged. I'm watching the movie. I feel good. Your brain learns that like, Oh, okay. So if I am at this signal, then the movie stays big.

And now I'm not bored or annoyed. And if my brain emits this signal, I don't like that because now the movie's going away. They actually taught it. cats within like a couple of [00:24:00] sessions of reinforcement that by feeding them certain things whenever they emitted a certain alpha wave that was only emitted when they were in heat, they learned to emit it within a couple of sessions in order to get food.

Wow. Wow. Is there anywhere outside of a clinical setting that would give you this same type of experience? Yes and no. So I am board certified in 20 channel neurofeedback. There are a couple of companies out there that have come out with like home neurofeedback devices. I do have a couple of those at my practice.

I'm trained in it. And, uh, I, Those ones are not, uh, there's not as much research backing them and it's something that, you know, I really do think because it's so hard when you're working with EEG, uh, because artifact is so easy to be picked up like cell phones and all this like static noise that's going on can really create issues.

So I really say having someone that can hook you up and monitor what's going on with the signal is [00:25:00] super important. But there is home neurofeedback sets. I am, like I said, I'm just a little weary and don't necessarily want to tell people go out and buy these because they're not, you know, empirically supported.

And you just don't have the training to kind of, uh, give it the same go. Plus it's only one channel as opposed to 20 channels. And that just means that it's only focusing on one small area of your brain. And so Instead of doing what I focus on, which is Loretta neurofeedback, so that's 3D imaging of your brain in order to work towards like very specific symptoms, um, and behavior changes.

So I'm not saying, you know, absolutely don't do it. I think that it has its own place and it can be really helpful, especially as a supplement, but there is, it's available to those where neurofeedback just isn't possible. Okay. That is so interesting. Are there any drawbacks or risks in neurofeedback? Okay.

Thank you. So not really. Um, there's not really any documented side effects. The biggest one that we've really been able to see seems to be [00:26:00] secondary to the cap, which is headaches. So because it's like a swimmer's cap, it kind of like it is tight because we need to have, you know, those, uh, electrodes as close to your scalp as we, as we can get.

So that that's one side effect that I hear a lot of people also report just feeling tired after a session because yeah, your brain's kind of it's like a workout for your brain. So people do get, you know, a little fatigued afterwards, but I've never heard anyone saying that it lasts longer than like a couple hours or something like that.

Uh, no other documented side effects or risks or anything like that. Definitely much less than the medication. Right. So, uh, really, really, um, not too many. things associated with it now. I want to try it. Have you ever done it, Andrea? I haven't. I want to try it. Is there anyone that wouldn't help? It seems like that would help anybody.

It would. I mean, if it's not going to help you, I'm going to let you know through the QEG. So remember, people come in and they get a brain scan and I'm able to look at their brain. And so I'm going to say, Oh, you know what? This is actually looking pretty good. This seems to be more of something that would be [00:27:00] responsive to like cognitive behavioral therapy or, you know, emotional regulation or acceptance and commitment therapy, like.

Here are some other recommendations I'm providing based upon the results of this, of this QEG, but no, and I've treated, you know, most common is ADHD. Absolutely. Second, most common is OCD. And then I've had some really interesting cases. One in particular was a 16 year old boy that came in and he felt like he was on a boat.

So most of the time this happens after getting off of like a cruise or something like that, he did not know what triggered it. But he had gone to all of the prominent hospitals, like so many doctors at this point, so many different medications and nothing had helped. He came in and I actually saw a little spot in, like, uh, right above his ear, that part of his brain, like the temporal lobe, that had a lot to do with balance, uh, perception of balance.

And everything else was green. Like, it looked great. He had a, he had a really great functioning, you know, brain, which made sense. It was the only thing he was experiencing. So I just trained [00:28:00] that very slowly. small area in his temporal lobe and it went away. So I think it stopped in like 12 sessions of neurofeedback.

Wow. And he did not have that sensation anymore. So we can treat very specific things. We're, we're going to see it backed up in that brain scan. When, when you come in and say, I'm experiencing these issues, I should be able to find it in that brain scan. And then we can do neurofeedback according to that, that scan.

If there are multiple things going on, because I, you know, there's obviously a lot of mental health stuff has comorbid, you know, I don't. diagnosis or whatever. Do you work on one independently of one another? So like if they've got O. C. D. And A. D. H. D. And yes, I do do those separately just because yes, if we're looking at A.

D. H. D. That's usually within the frontal lobes. And if we're looking at O. C. D. A lot of research has indicated that that's actually within the occipital lobes, which is strange because that controls like vision and eyesight. But there's something to do with rumination back there. We also see a lot of O. C.

D. In the center strip [00:29:00] of the brain. Although I can train like upwards of 140 indicators at a time, I think that it's, it's best to focus on one area, but I have had people come in and focus on one thing for 20 sessions and then focus on the next thing for 20 sessions. So they do two full protocols of neurofeedback training in order to, you know, kind of conquer.

And then I've also had some people where I just focus on one part of the brain and that actually clears up another part. Because sometimes there's like this traffic jam that's going on in the brain. So it creates all these effects and when you get to the root issue of it, all those after effects actually clear up too.

Wow. I saw my daughter do this. She went through neurofeedback about, I want to say like seven years ago. I think she got through 10 sessions. It was fascinating to watch the movies and see how that feedback was transmitting signal to her brain. So I really appreciated. that science part of it. But what I didn't appreciate was how expensive [00:30:00] it was.

And it made me sad because I knew she probably could have used more, but then we just kind of had to tap out. Is there any change? Does insurance cover any portion of that these days? It was something that was going on in the neurofeedback world, just like with any profession, right, there's all these subsets and the world of neurofeedback, all these, you know, very smart people just working really hard, and it seemed like there was a little bit of politics involved there, where some wanted insurance to cover it, some didn't, because, you know, insurance comes.

rates aren't really that great either. And it is a very expensive thing to run. So the software and all of that is expensive for clinicians. So they're not just kind of pulling this fee out of nowhere. I would say that some clinicians have found success in billing it under like a general biofeedback code because neurofeedback is biofeedback, but a lot of insurance companies are still saying this is not.

Been in the research for long enough, or we need more evidence to to support this and they're [00:31:00] like, you know, declining coverage on it, which is super frustrating. I do see it going in that direction, though. There's just more and more research coming out, and I do feel like that's the direction it's going to go.

One thing that we do at my practice, which I believe is very helpful, um, and we do this for neuropsych testing as well, is we've got students every single year that, that we're teaching. And so we give student rates where I'm still creating the protocol, doing the feedback, changing the protocol when I'm completely involved in everything, but it is my trainee that's kind of hooking the patient up.

And that gives you like a 75 percent reduction in rate. So these rates are like a hundred dollars, you know, per session, as opposed to like the three, four, five, you know, a hundred that you could see from board certified clinicians. Oh, that's great to think about. Are the effects permanent? Usually the way that I describe it is like, once you learn to ride a bike, you don't really forget how to do it.

Now, if something happens, right, like a trauma, it [00:32:00] can affect your brain chemistry, and it can revert back in some ways. But it is not like medication, where when you take medication, it alters your brain functioning. And when you stop the medication, it reverts back. Neurofeedback is changing how it is that your brain functions.

Once it learns to function a certain way, it doesn't really have interest in going back to, you know, negative means of functioning. Wow. I'm so excited to kind of look into this, honestly, for myself. But that being said, if we can't go see you in New York, and I, and I have seen that there are a lot of other places where we are in Colorado.

Can you advise or describe what somebody would be looking for? in a practice. Yeah, you always want to look to make sure that somebody is board certified. Okay. This is really important just because anyone can actually go and buy the neurofeedback equipment. Um, you can go and buy it and then you can create a website that says I do neurofeedback and nobody trained you.

Um, there's It's [00:33:00] not like the field of psychology where there's a licensing, you know, where you, you absolutely cannot call yourself, um, like a practitioner or a clinician, unless you have this type of training. So you always want to look for board certification. I usually say that the best way to go about this is to go on like the.

ISNR, which is the International Society of Neurofeedback and Research, or to go into BCIA is usually the best one. That is where they're actually giving the board certification, and you can search for providers in your state. Okay, that is so helpful. Thank you. It's so helpful. I mean, and you know, a lot of kids people in general are resistant to medications or have such severe side effects from some medications.

I know that my, um, my daughter just we've probably had her on 15 different medications and she just can't find anything that works for her. And we haven't tried neurofeedback. We've done biofeedback, but now obviously I'm like, yeah. ready to jump on those [00:34:00] websites and think, I need to find one here real soon, no matter how much it costs, because there's got to be some relief.

It's painful to watch her try to go through all of this. And she just gets so sad every time she has to change a medication or try something new. She's just, it's heartbreaking, you know, it's heartbreaking. So. There is hope there. Yeah. Now I'm going to take us in a little different direction because we're talking about, um, technology, but I would like to know what your feelings are on how technology and the internet are affecting our kids brains and as parents what we should be looking out for in protecting our kids.

Yeah, I mean, look, research shows that there's negative impacts right with technology. It's giving our kids these immediate hits of dopamine, right, which is a neurotransmitter that affects mood. It's kind of like the same thing that is activated with drugs and alcohol. You can even get a hit of dopamine by eating like your favorite [00:35:00] chocolate or something like that screens.

They kind of have the same effects. And the more that you're on screens, the more that you need, just like with any drug or anything where you're getting consistent hits of dopamine, you need more and more and more to get the same effects until you've kind of depleted your dopamine. And then at that point, it's very, very difficult to get it.

You're almost needing the screens to even just feel like normal as opposed to the actual dopamine, which makes you happier. So screens, absolutely. We see an increase in irritability, anger, behavioral problems, outbursts, negative school performance, sleep issues. So much is associated with, you know, too much screen time and it's absolutely affected, right?

Like our, our teens, our, our kids and immediate, you know, gratification and kind of that area of, of patience, which also translates into issues at school and, and behaviors as well. [00:36:00] So there, there's a lot associated with screens, particularly just like the ease and access of it. And a lot of schools now are even, you know, providing tablets for their kids and having, you know, computer time during school.

So it makes it even, even harder. And I think something that just makes that even doubly hard, right, is a working mom that knows that a screen is going to help her get through, you know, uh, their child is sick, or they just need to cook dinner real quick, or their kid is just bugging them so much and they've had a hard day at work.

And I hate the concept of just like shaming, right? Like we've got to do what we've, we've got to do, but yes, screens definitely when used too much can have negative impacts. And a lot of parents aren't aware, particularly related to behavior and irritability, how linked it can be. Does it matter what's on the screen?

It, it matters somewhat in that, yes, you know, if they're watching something violent, that can definitely have a different effect than if it's [00:37:00] not violent, but they all kind of have the same effects related to just like increased irritability and increased negative behaviors. Jeez. You know what terrifies me is My kids were the product of baby Einstein and we thought this was amazing.

It was so great. And I'd put the baby in front of there and I'd be like, Oh so wonderful. And now I'm thinking, Oh, I was just flooding their little brains with dopamine. I've messed them up for their life. We thought we were making them smarter. We did. Well, and you know what? Some of those programs though, like it is teaching them things that can be positive.

And it's not that the screen is just this evil thing that, that you should completely stay away from. It's just like, we're not going to stay away from other things that give us dopamine, like going for a run or hugging someone, you know, these. things. It's more so about, we don't want to get to the point where it feels like an addiction.

And we don't want to get to a point where it feels like we need it in order to feel some type of dopamine release, right? So some TV, especially if it's [00:38:00] educational, you know, baby Einstein going over certain like music and things like that. It's not necessarily the worst. thing ever. It's just, yeah, if you are doing it, uh, you know, all day every day, then of course, yes, that, that's definitely going to be an issue.

Um, so regulating screen time, I think really is the message here. Not so much taking it away. I have so many parents that come to see me. They're like, all right, no more screen. And I'm like, Oh, hold on. We do that. That's actually going to create more negative behaviors and more of a problem. So it's something that we really need to work on.

Reducing it slowly, giving them, you know, control and giving them alternative means of dopamine production and making them feel in control of it as well. So we don't just want to completely take it away. Well, thank you for, for validating me and making me feel like I wasn't a horrible parent for putting them in front of the screen for a couple of hours.

Definitely not. I saw that you use, speaking of screens, virtual reality as a therapy. Can you speak a little bit about that? Yeah, yeah, absolutely. [00:39:00] So I usually combine VR with biofeedback. So the virtual reality is just a means of exposure therapy. So if people come to me and they are, my most common one is fear of flying.

People are scared to fly on an airplane and that's really difficult to do exposure therapy with because you're not just gonna. Purchase a bunch of, you know, airplane tickets. And also it's so scary and you're kind of trapped on that plane that it's hard to do a hierarchy, which is what we do with exposure is we introduce them to small little bits of what they're scared of and work our way up.

So with the virtual reality, I put them in a plane and they they're in the VR world. They look left, right. They can see seats, you know, next. To them, they can see the door. I can control if like the fashion seatbelt, uh, signal comes on. I can control if there's turbulence, I can control if it's raining or if it's sunny.

Uh, and then I take them through like a takeoff or a taxi, a landing mid-flight. And so I'm also combining that with biofeedback. So I'm [00:40:00] teaching them how to get into heart rate variability while they're. to, um, the stimulus that makes them panic. So then that reduces the phobic response and it makes it to where they are now able to fly.

Wow. My daughter did biofeedback with, um, and, uh, virtual reality with needles, but they had to, they, they put the, um, like she was in a clinical setting for the virtual reality part, but the psychologist actually had a needle like holder that, so she touched her arm with it. And, um, Yeah. Let's just say it was not fun to watch for the first few times.

I was like, Oh my goodness. This is awful. But it helped. It helped. She was able to, you know, get some of her vaccines that she needed and no goodness. It was, it's tough for them, but effective. Definitely. You know, Emmy and I have talked. I don't know how many times. We [00:41:00] firmly believe that anxiety and depression and mental health challenges are on the rise in, in kids these days, much so much more than when we were kids.

Definitely seems that way. It sure seems that way. We've had some people tell us that they don't believe that, but what's your opinion on that? Um, do you think that mental health challenges are on the rise with kids or? Yeah, I mean, absolutely. I think it's well documented, you know, posts. COVID, right? That, like, absolutely, there's a pretty significant issue.

With kids and mental health and it's definitely on the rise. I think even before COVID though, that was the case as well. And I think that that's just school pressures, changes in how, you know, parents are parenting, expectations, college, extracurricular activities, pressures. There's just So much more going on.

And also there's just more awareness too. So it's not so much that say, for example, um, autism [00:42:00] spectrum disorder didn't exist, you know, 20 years ago, it's that it just was something that people didn't talk about. Clinicians weren't as educated on it. It wasn't something that you could really, um, find treatment for easily.

And now there's been a huge change with that. So it is something where I think that it's. It's twofold. There's just more awareness, more knowledge now, but I also think that particularly with kids, I mean, I remember, right, my summers, like I didn't, it wasn't chock full of like coding camp and ice skating, you know, uh, and all these activities and summer schools.

And I had just a teenager go to a college readiness program at Hopkins for three weeks during his summer. And it's just, yeah, I think that there's a lot of this pressure. You see it really intensely in New York city as well, but it's everywhere. It is everywhere. The pressure is everywhere. These kids are under such pressure at such a young age.

You know, we [00:43:00] try as, as parents to not put that pressure on them, but it's coming from every place else. I don't understand what, where that drive has come from and what we're doing to the, to our kids. We're not letting them just have fun and be kids, but I'm thinking that was even before COVID. I'm sure COVID is, is, you know, only exasperated all of that, but that was before COVID.

I mean, my kids were dressing up for college, what college they wanted to go to when they were in first grade. And I remember thinking, why are we doing this to them? They shouldn't even be thinking about second grade at this point. They should be thinking about lunch. Yeah, yeah, no, it is. And it's this idea too that you've got to get all these extracurriculars in.

And it's because, yes, colleges have gotten so competitive and it's this attitude. Um, I've even had parents reach out to me needing assessments to get their kid into like the best. Preschool and it's, it's wild. Um, you know, how much pressure we're putting on these kids. So I do think that that's a big part of it.

But I think too, [00:44:00] it's, it, like I said, it is this awareness and a lot of other things are going on in the world too, with a lot of ease of access to it. So, you know. All of the things that's going on with the world just at your fingertips on your phone, constant, just like flooded stimuli that also is affecting our brain chemistry, like all of these things can, can have an effect on mental health.

What advice would you give to a parent of a child that you feel, you know, that they're sensing, you know, most of what comes is you're sensing something's not quite right with your kid. What advice would you give to a parent that's maybe having these feelings? Yeah, I mean, I really just try and encourage that there's nothing that you have done with your parenting if your child is experiencing any type of mental health symptom, anxiety, depression, OCD, anything, ADHD, it's not a direct Result of your parenting.

It's not an indicator of what type of parent you are, and it is important for you as a parent to get [00:45:00] help. Right. And just to seek out help when you can. So being able to have a consult with a psychologist, a social worker, a mental health counselor, being able to kind of. Just start where it's free and easy access with like a school counselor.

Get a referral, you know, go and get an intake at like a community mental health clinic. Be able to just talk to someone that can kind of walk you through it because the internet is a scary place. And if you go on and Google, you know, my kids anxious and then all of a sudden you're on like a subreddit from 10 years ago about how some kid failed at life because they were anxious.

just not, it's not helpful. I'm all for support groups. Um, and I do think the internet has its place, but I definitely just advocate, like, don't think that this is due to something that, you know, like, Oh, my parenting, I'm a terrible parent. So I can't, you know, I don't want to go to a psychologist and admit that it's really just being able to like go and go and talk it out.

And maybe the psychologist says, Hey, you can actually [00:46:00] handle this at home or through the school, but they're, they're going to be able to help you through that. Okay. You know, you say that you look at medicine as kind of a last resort, and I know there's some big proponents on both sides of that. Are there any places that parents can go to read and formulate their own opinion as to whether or not they, you know, which, which avenue they want to, they want to take?

Would you have any recommendations on that? So, I mean, you can always go on the actual, you know, medication like website and read side effects associated with it and things like that, but really the best thing I advise is a psychiatric evaluation. If you're interested in medication, make an appointment with a psychiatrist.

You do not have to take the prescription home. You don't have to fill the prescription. You don't have to take the medication, but that's going to be your best bet. Place to get information on. Hey, what are the side effects? What medication would you advise me? Take? Why do you advise that my symptoms are a B and C?

Why are you saying that this would be helpful for me? [00:47:00] They're just going to be the ones that like I said are going to really help you through it So that's that's what my advice is. I know it's not always possible, but it's possible. That's what it is that I would advise What do you think is the biggest mental health challenge moving forward for kids and parents these days?

And then we'll wrap it up. You know, I think a really big problem that I see at least a lot in New York is just the over scheduled, over stimulated child. And the parents are coming to me, and they're kind of saying, Okay, well, they've got soccer from 4 to 7, but then there's school, but they've got this after school debate club, but then they also have skateboarding camps on Saturdays, so they can maybe see you for 15 minutes on Monday at 6 o'clock.

And it's like... When does this child eat? When does this child leave? And is therapy just going to be another thing that they're being kind of like chauffeured to that is they're just like turning their brains off and going into autopilot. So I think it is [00:48:00] just, there's a lot going on for kids. And I think that that's a big challenge because I don't want to discourage afterschool activities.

I don't want to discourage sports. I don't want to discourage academics, but at the same time, it is something where I do see that as, as a problem. For kids, it's just a lot of pressure to do a lot of different things from both school and parents. And getting the help that they need sometimes can take a backseat or it can become really hard to, to manage.

Yeah. Our kids are, life has become incredibly busy and we're bringing that on to our kids. And I think you make a great point about we don't want therapy just to become another checkbox. You know what? Oh, well, my kid has to do this. So I'm going to put them into therapy and they're not even engaged in it.

Mm hmm. Heather, I'm so thankful for your time. This has been probably my favorite conversation in a long, long time. It's just so much good, good information that is, I think, applicable to me personally. I [00:49:00] feel like my kids, but I think everybody just how we started out talking about breathing. I mean, gosh, if nothing else, we can always pull that tool out of our tool belt.

So thank you. Thank you so much. Yeah, absolutely. Yeah, you are just fascinating. I just love to hear about the new technologies and, and what you're doing. And I hope to keep in touch with you as we, uh, as we move forward. So, because yeah, you know, kind of geek out on this stuff. And if you ever come to San Diego, come say hi.

So, yeah, absolutely. Absolutely. Well, Heather, thank you so much and we look forward to hopefully talking to you again one day. Yeah, definitely. Thank you so much for having me.

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