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The Integrative Palliative Podcast
Conversations about communication, caregiving, and changing the experience of serious illness.
Hosted by physician, educator, and speaker Dr. Delia Chiaramonte, The Integrative Palliative Podcast explores one central question:
How do we improve the experience of serious illness when we cannot change the illness itself?
Through thoughtful conversations, practical tools, and evidence-informed insights, each episode helps listeners navigate the challenges of serious illness with greater clarity, compassion, and confidence. Topics include communication, family caregiving, clinician wellbeing, decision making, whole-person care, and the emotional realities that accompany serious illness.
Whether you're a healthcare professional, a family caregiver, or simply someone walking beside a loved one through illness, you'll discover practical skills that can improve your confidence, reduce your stress, and help you find meaning even if the patient's illness can't be cured.
If you're a caregiver, visit www.DoctorDelia.com for information about programs, resources, and personalized support from Dr. Delia.
If you are a healthcare organization or interested in discussing speaking or consulting with Dr. Delia, visit www.integrativepalliative.com.
The Integrative Palliative Podcast
Remote Neurofeedback: A Conversation with Francesco Amico and Alvaro Villegas
Use Left/Right to seek, Home/End to jump to start or end. Hold shift to jump forward or backward.
Neurofeedback is a brain-based treatment that is effective and safe. It can be used to manage ADHD, anxiety, depression, insomnia, Parkinson’s disease, mild cognitive impairment, post concussive syndrome and more.
This week we have Francesco Amico, PhD and Alvaro Villegas who are experts in neurofeedback, especially neurofeedback that can be administered remotely, sharing their expertise.
They work with a product called Myndlift that allows people to have personalized neurofeedback treatment from their home. More information about Myndlift is available at www.myndlift.com.
Dr. Amico can be contacted at linkedin.com/in/dr-francesco-amico-phd-b7170649
Mr. Villegas and Dr. Amico can we reached at www.helloneotherapy.com (Spanish and English).
Let’s be Sage Clinicians who provide whole person care to people with serious illness, using all the tools that work.
Dr C
Delia Chiaramonte, MD
www.integrativepalliative.com
Coping Courageously: A Heart-Centered Guide for Navigating a Loved One’s Illness Without Losing Yourself is available here: www.copingcourageously.com
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Welcome to the Integrative Palliative Podcast, where we help physicians and other clinicians master the art of integrative symptom management so they can wholeheartedly care for themselves or they expertly care for their patients. Welcome to the Integrative Palliative Podcast. I'm Dr. Delia Claramanti, and today we're going to talk about a really important topic, neurofeedback. And we have two experts with us today, Alvaro Vejegas, who is a medical engineer, and Dr. Francesco Amico, PhD, who is has expertise in using neurofeedback, particularly remote neurofeedback. So I'm going to let them introduce themselves and then we're going to get into the nitty-gritty of neurofeedback. So, Dr. Amico, can you start us off? Tell us a little bit about yourself.
SPEAKER_01First of all, thank you for having us. My first degree is biology, so I'm a biologist and a neuroscientist from the School of Medicine and Training College of Dublin and Ireland since uh 2018. I've been working on um but involved in uh um neurofeedback research. I uh started started working with a very exciting uh piece of technology, which is uh uh mindlift, which is a uh a platform to deliver neurofeedback uh remotely. This platform has allowed me to uh provide a service for patients who can't really or are not that mobile and can't really reach a clinic on a regular basis every week. Of course, during the pandemic, this has been absolutely key because most clinics couldn't operate if not remotely.
SPEAKER_00Terrific. Thank you. So we are definitely going to talk about mind lift, about what NERF feedback is, about what's the difference between in clinic and at home. Mr. Vijaygas, tell me a little bit about you and then how you two started working together.
SPEAKER_02Okay, yeah. I'm um, as you said, I'm a biomedical engineer by trade. Uh spent about 23 years on the diagnostic imaging service. And in 2008, I my sleep was uh disrupted to say the least. And I became in contact with neurofeedback. And I guess if you ask every most of the people that are involved in the field, is because in Huawei, in one point in their life, they actually were able to experience neurofeedback. So uh that was uh a game changer for me. I regained my sleep within I would say three weeks. I was sleeping back as a kid. Uh so from that point on, I became involved in neurofeedback. I moved to the state and we established here what we have in my original country, Venezuela, uh neurofeedback service here, in-office neurofeedback. With the pandemic, the ability to serve our clients was of course disrupted. And uh, we we began to look ways on how can we still help, and especially at that moment that everyone was so vulnerable, uh, how can we knowing what neurofeedback can do, to how can we bring neurofeedback to to the actual client? And that's where I came in contact with uh Dr. Amigo. Then we have joint forces to deliver this wonderful uh and very effective therapeutic tool to not just the people that are around us, but worldwide.
SPEAKER_00Terrific. Thank you very much. Yeah, I also have had this experience of multiple people in my family. Anxiety, depression, and post-concussive syndrome had marked improvements with neurofeedback. And so I've been interested in it for that exact same reason. I agree with you. Once you experience how much it helps, you want to know how come everybody's not using it? Right. And and this change of being able to get personalized neurofeedback at home, I think is really crucially important. But before we get into that, can one of you, I'll defer to you about who should take this one on, tell us what is neurofeedback? And please remember that the people listening are not experts. When you're an expert, sometimes you speak up here, but really like what for someone who says, I never heard of that, what is that? What is neurofeedback?
SPEAKER_01I'll jump in. Okay. Neurofeedback is a um is a is a learning-based intervention with uh which is completely non-invasive. And in 50 years of yours, which has shown it has shown no set effects. The way it is delivered is through EEG. A patient or user is asked to uh to perform in a task, typically watching a video or playing a video game, and an electrode or more than one electrodes are placed in a region of the skull. What happens is that um when a condition is met, the patient will be able to watch the video or perform, actively perform the game, get a reward. This uses a what in neuroscience called open conditioning, and the operand conditioning loop, which is pretty much how all animals, including us, uh, operate. Basically, our behavior is shaped through opium conditioning. So we get a reward every time our brain understands that that behavior is particularly significant to our survival. Now it's um it's a it's a positive in the case of the neurofeedback, it's always a positive reward, it's never a negative reward. In other words, we don't get a shock or anything.
SPEAKER_00Thank you.
SPEAKER_01So which is a good thing. Um so so if, for example, if um a particular frequency uh in a specific region of the skull is achieved, um, if the work if the the brain works within a particular frequency range in a specific region of the skull, for example, if I'm watching a video, so I'll be able to smoothly uh watch the video, otherwise the video will dim and the audio will go down. So um the brain quickly learns that in order to watch the video and has to function in that using that particular particular setup, which is set up by a neurofeedback practitioner, by the way.
SPEAKER_00If I may try to summarize and make sure that I understand. So you are through operant conditioning trying to reward certain brainwave states, right? So for example, alpha brainwaves are associated with relaxation. So maybe you want more of those to be very simplistic. Exactly. Right. So when the person's brain is showing you the brain waves that you want, like relaxing alpha brainwaves, for example, they will get some reward. Like their movie or video becomes brighter and louder and they can watch it. So then by doing that, you're teaching them, please give me more of those brain waves.
SPEAKER_01Exactly.
SPEAKER_00To be simplistic. I understand I'm oversimplicified. Is that right? It's generally right for the concept.
SPEAKER_01Yeah, that's it, that's the concept.
SPEAKER_00Okay, terrific. And so from the patient's perspective, they are have some monitoring EEG device over their head that is that is monitoring what's happening in their brainwave so that you know when they've done the right thing, so they should be rewarded. Exactly.
SPEAKER_01Exactly. And uh again, depending on uh on on the platform that uh that is used, uh, there are different ways. Um typically, in a, for example, a neural feedback delivered in clinic, uh patients have to wear a cap, uh, which takes only you know five to ten minutes to um to place and um on stock, and uh it's connected, it's wired to a laptop or something yeah, to a PC, or um and um yeah, and it's and it's ready to go. In the case of remote viewer feedback, in particular of um uh mind lift, we use a uh low density path, which is a very, very lightweight headset, um, which is very, very easy to uh uh to place behind the ears and uh around the head, basically.
SPEAKER_00So it goes across their forehead and then behind their ears, and they just put it on themselves.
SPEAKER_01No, not behind. Uh and also there's also an external electric which which can be which the patient can move around, basically. Okay. Um the interaction is through an app, so the patient can use wirelessly a phone, tablet. Um, and so it's and very, very easy to interact, and all the training is delivered through the app.
SPEAKER_00Got it. And so you guys program what they should get rewarded for, right? So every patient has an individualized experience. This headset is an EEG, right? A simplistic EEG that's reading something that gives you information. You decide what to reward, and then that goes in the app. Is that how that works?
SPEAKER_02Yes.
SPEAKER_00Maybe this one, Alvaro, is for you. Is it just from the beginning you decide what they have and it stays in the app the same? Or is there interaction like over time as they change or you learn from them? Do you change the what gets rewarded?
SPEAKER_02It's not interactive. It's it's not always a fixed uh set of as as you go as you train and the brain learn or the new patterns or that we're trying to establish, then we're able to achieve the training. Okay. And as well, you could start with uh let's say you're having trouble sleeping, right? We could start with sleeping, and then you want to include in the mix uh concentration. It's not a set a set of protocols that stay with you throughout the training. We change the protocols as as as needed.
SPEAKER_00So as you see something different when you're assessing their brainwave function, but also as their goals are different, right? Right. So like I teach my dog to sit, and then once he learns that, I can teach him to stay. So you can you can reward sleep, and then you've done good. Now sleep is good, now you can reward concentration. Is that right?
SPEAKER_01The whole thing starts with patients going to um for a doctor appointment. Patient talks about the problems. For example, if the patient has sleep problems and anxiety and, for example, symptoms of depression, we start everything setting up uh questionnaires, standard clinical questionnaires that use in medical research um and the practice, uh, to uh to see what the patient feels like on a regular basis, by the way. Um, so we get information from the patient directly. So instead of um asking them, How are you? How are you doing? So we know we ask them um questions, standard questions. Every questionnaire at the end will give us a score. So and we keep track of that score throughout the training, throughout the months. So uh so we start from to summarize, we we start from uh what the doctor gives us. Uh so we we want to be in direct contact with the doctor on a regular basis. And uh then from then on, we uh we develop our way to assess uh through the mind lift app, by the way, to assess the patients each and every month.
SPEAKER_00So they have to see their own doctor or they see a doctor through you guys?
SPEAKER_01They um no, no, no, they have to see their own doctor. We want them to their doctor to refer them onto us. Um, and uh of course, it must be like you said for example, um the patient comes to you and you know us, uh, so uh you put uh the patient in contact with us. And then from then on, we take it from there, we establish a direct contact with the patient. And um also um if the patient needs a further explanation or support, motivation throughout the training, it will access uh will have direct access to me through Zoom uh Zoom calls, and uh also if there's any troubleshooting and technical issue, they have access, direct access to uh to mind lift, which is has a an amazing technical support uh staff that takes care of everything.
SPEAKER_00So it goes across the forehead, then then hooks behind the ears. Is that right?
SPEAKER_01Yeah, that is correct.
SPEAKER_00So I hear you. I think that's wonderful, actually. That the people go to their doctor first so that if they have they get assessed, do they really have depression? And there may be other treatments that you would want to do for that. Do they have anxiety? Is it under control? Make sure they're getting wraparound care, but then the specific use of neurofeedback they get through you and they can do remotely, right?
SPEAKER_01Exactly. And the important thing is um neurofeedback is can be used as a standalone or complementary intervention. So um the patient uh or the doctor doesn't have to uh prioritize uh, for example, pharmacotherapy uh or neurofeedback. They both we know from research that uh the results, the clinical outcome is greater if multiple strategies are combined. So uh if, for example, pharmacotherapy and um EMDR, for example, in the case of uh trauma patients and neurofeedback, they can be combined.
SPEAKER_00Yep, absolutely. That was my experience with my family member too. But we we didn't start them all at once, so we did other things first and then added neurofeedback and saw a very clear change after neurofeedback for multiple family members.
SPEAKER_02What we have seen here is that neurofeedback enhances all the therapies that you're doing at the same time. So that's usually what patients prefer that once they start to introduce neurofeedback in their mix, everything else increases the level of effectiveness.
SPEAKER_00So, what was your experience, Alvaro, when you did neurofeedback as a patient? What what was it like for you?
SPEAKER_02I wasn't sleeping, I was taking medication, as I like to tell my clients, to sleep an elephant, to put asleep an elephant. And on me, it was doing the contrary. I I was extremely overexcited. So the little hours that I was getting, it was about two hours of sleep that they were in the morning. For me, I it I had to do something drastically because medication wasn't helping, it was on the contrary, was increasing my anxiety, my not being able to sleep. So uh my father is a neurologist and he was doing neurofeedback in in Venezuela, but he was targeting the drug addiction population. Okay, so I I I went to him, look, I need your help. So he said, Oh, why don't you try neurofeedback? And I say, anything as long as I'm able to sleep. So we did what we call an intensive program, meaning there was a training more than usually, like four hours a day. So within what I started noticing is like around the first week of training, I was you know, uh feeling less anxious. My mind, the the the noise in my mind was diminishing, and at the second session I began to sleep at night. So it started like one hour. Then at the end of that second week, I was sleeping three hours, then it came the third week, I was able to sleep eight hours. But but for me, that's a and I was on medication for about uh four to five months. I would like to more or less. So it was a very, very dramatic change for me. It was like this is amazing.
SPEAKER_01You were hooked, yeah.
SPEAKER_02Yes, yes.
SPEAKER_01Very, very uh important story, Alvara. It makes me think actually of um all the different uh patients that I have that I work with, who haven't a lot of them have deal, you know, they struggle with sleep, with poor sleep, which uh makes them hyper-vigilant, not just at night, but during the day, even when they close their eyes.
SPEAKER_00So they can't turn their brain off when it's time to sleep.
SPEAKER_01And this is typical, for example, of people who work late or people with uh anxiety and depression who tend to engage in rumination a lot. Right. So uh we know in these people, in these patients that are better and high beta frequencies are very high. It's like um when I try when I explain it to patients, it's like when you're stuck in the mud and um you know you hit the gas, um, but you're not going anywhere. So, but what happens is that you're using your gas, you're you know at some stage you will something will happen you and first of all, you're not going anywhere because it's stuck. So that happens during the day, but at night, it's like you're you you just can't stop. You can't, you know, you can't wind down.
SPEAKER_00Yeah.
SPEAKER_01So all if they don't look at the EG, uh, or what we use the quantity e g or q e g, what the only uh the only option for clinicians is to switch from drug to drug. And uh it's which can be very uh we know that um it's pretty frustrating for both for of course for the patients and for the clinician. Uh doing instead the ground work and looking at the uh the EJ maps, the QEG maps, at least gives us a um uh an idea, uh number of cues, and uh so we know where on what uh to work. And also we can work with the clinician and explaining um well brainstorming on what um pharmacotherapy could uh what kind of uh drug could work in that for that particular patient on the basis of the results that we have.
SPEAKER_00That's very interesting. I really like that about neurofeedback, the the combination of you can talk to the patient who can tell you, I try to sleep and I can't turn my brain off, and I'm just thinking, thinking, thinking about all the terrible things that could happen tomorrow. And then you can put the QEG on their head and see that they're stuck in high beta, right? And that those two things map together. And then now you're gonna help treat their brainwave function with reinforcement and operate conditioning, and then they they perseparate less, right? And catastrophize less when they lay in bed. That that's really the mind-body connection. It's so real and tangible, but also manages people's emotions. And I love that it really is the combination of the mind and the body together.
SPEAKER_01Absolutely. We're looking for uh ways to tackle the imbalances and neurobehavioral imbalances before they get really bad.
unknownYeah.
SPEAKER_01Uh so uh we talked about early detection of, for example, Alzheimer's disease, early detection of depression. One thing that uh I'd see with most of my patients, and it's typically seen um in uh neurofeedback practice, is that uh changes in the EEG, in the QEG, occur before, very often before the manifestation of symptoms. Wow. So um a patient, for example, is not aware of a sleep problem, but is kind of fatigued during the day or not particularly focused, or maybe scores really bad, had very low reaction times um in a um in a cognitive cognitive task. And uh, but the patient maybe didn't come to you because of a sleep problem, or maybe develop some sleep problems along the way. Then I look at the maps and say, okay, there is something that is maybe if you're sleeping deep enough, respirative sleep is not good enough. So I start targeting those um those um frequencies in those regions that I I believe are most likely linked to uh to poor sleep. In the case of uh MCI, my mild cognitive impairment, we know from research that if we tackle MCI early enough, we're more likely to slow down the progression of um dementia of all kinds of diseases. With neurofeedback. No, with neurofeedback in general. If we know, there are of course neurofeedback studies showing it, uh, but if we in general, in general, we know that if we we we uh if we target MCI at the very early stage, the progression in some patients actually it doesn't progress into uh at the former dimension. In some patients, the progression is slower, right? So um, of course, you know, and neurodegenerative disease diseases are characterized by the fact that cells die die off, so we can't really stop that with neurofeedback. Um, but we can give the support uh facilitating changes, functional changes in the brain, uh um that um optimize function of the cognitive domain.
SPEAKER_00You can optimize the function of the brain tissue that is intact.
SPEAKER_01Um yeah, uh now let's keep in mind that um uh we uh we we work on the assumption that EG reflects the activity of the under underlying uh underlying brain, right? So uh we of course we're not recording, we're not putting the electrodes inside the brain. We're not right doing uh we're not going to so it's completely non-invasive. So there it's like I think the metaphor that works is really, you know, it's um uh instead of going inside a computer, we put our hands on the computer and we know where it's it's hotter, we know where where there's more vibrations. So those vibrations reflect the activity of the inside of the computer, but again, not the computer.
SPEAKER_00Right.
SPEAKER_01So that's pretty much what all EEG is based on.
SPEAKER_00My family member had had an experience that I found so interesting. They were post-concussion and were getting vision therapy also, which was doing some objective tests like how fast can you push these buttons? And we had had been doing that for a while and then started neurofeedback and was markedly faster. And the therapist said, What on earth did you do? Because and I was watching what how fast this was going. And it was a marked objective change. I was just shocked.
SPEAKER_01Well, that's um uh that's that's amazing, by the way. I'm I'm very, very uh happy to hear that. What we do, what MindLift has in Bill to the app is a go no go task. So basically, um you had to tap as soon as uh you see something as a target stimulus, and so we measure everything. Um we measure reaction times, of course, which can be um uh can be slowed in case of neurological disorders, moderate neurological disorders, but also in the cases in the case it can be affected by inattention. Um, and uh inattention can be affected by psychological distress, emotion uh or emotional disorders like depression. So we can measure reaction times uh automatic, automatically we have also other measures, uh measures of focus and measures of impulse control. What uh what we know is that uh both focus, so it might seem like um that we're measuring just uh a dysfunction, we're measuring how the uh cognitive domain is doing, cognitive functions are doing, but actually we are measuring also two resources that are key to emotion regulation, which are focus and focus and impulse. So uh there you go. So we know that um if uh a depressed patient is improving in those two resources, and uh so we know that we're on the right track.
SPEAKER_02Building a little bit on what um Francesca is saying, it's sometimes you ask the actual client, what have you what improvement have you seen? And then he said, uh it's about the same. Uh I don't feel any different. And then you speak to a family member or uh significant other and say, This guy is a totally different guy. That happens with medicines too. He sleeps, uh, he doesn't fight with me that long. So I don't understand what what he's saying that he doesn't feel he doesn't, but I do.
SPEAKER_00Right.
SPEAKER_02So yeah, and keep going. Yeah, it's it's it's repetitive, it's not just one one patient that refers that. Uh you as as as the one that is being trained, you might not it's like if if you're watching yourself in a mirror every day, you don't see a change. It's a slow change, yeah. It's a slow change, but uh the the significant other, the wife is saying, No, wait, wait. This was your picture uh yesterday, and this is now. You might not see the difference because you're seeing every day yourself in the mirror, but I'm that's not my story. I'm looking to something totally different, right?
SPEAKER_01So basically, whatever you're doing, whatever you're doing, please do more of that and more money, do more. Do more. Please do that.
SPEAKER_00So so let's make sure let's make sure that we're clear for the the clinicians who are listening who they should send for neurofeedback. So we talked already about sleep, that there's benefit in sleep. We talked about benefit for anxiety and depression. What else? What should people think to send their patients for?
SPEAKER_01You mentioned TBI. I've recently published a paper on um review review paper on uh TBI, and uh we know that there are some key imbalances uh that are detected by QEG even years after um after the uh the concussion and uh incident, even when CT doesn't detect.
SPEAKER_00Yeah. Um wait, I'm gonna stop you for one second because that is so important that even years after concussion, people can still have effects from post-concussive syndrome, and neurofeedback can still work, right?
SPEAKER_01Yes, and we know that our um CT won't detect any any structural dysfunction. Right. Um but uh we know that EEG can. And neurofeedback, of course, in that case, neurofeedback can be used to target those imbalances that are detected by Q and EG. Um, in other so depression, uh anxiety, um of course ADHD. Um I've worked with a number of uh uh very, very young clients. So ADHD and of course in in children and adults, cognitive impairment, and I worked with also with Alzheimer's patients. And uh of course, again, you know, as a disclaimer, we are not uh uh we're not bringing those cells back.
SPEAKER_00So it's worth a try. It's worth a try for people with mild cognitive impairments. Exactly.
SPEAKER_01Um so uh of course, insomnia and restless uh restless like leg strength leg syndrome and um um stress disorder, PDSD. Um so uh so that's it is OCD as well. OCD, okay OCD, OCD for threat syndrome, uh tick disorder, PD as well, Parkinson's disease.
SPEAKER_02How I see neural feedback is there there are two avenues. One is that you're going to improve a condition that is deteriorating in some way or another your well-being. I don't sleep, I don't concentrate, uh, my mind is running all over the place. But on the other hand, if you look at it, if you have a more robust central nervous system to work with, which is the goal of a neurofeedback, then you can enhance and that your abilities. I mean, let's say you're uh you're a musician, you're an artist. Uh if you have if you train with neurofeedback, uh we have done with athletes, and then they perform better. It's not that they're coming to you because I'm not sleepy. No, that's not the case. I come to you because I want to improve my level of performance.
SPEAKER_00This is like going to the gym.
SPEAKER_02Neurofeedback is training. It's a training, it's like training for your brain.
SPEAKER_00Yeah, so it's going to the gym essentially, it's maximizing the function of your brain, which you could you could go to PT if your body falls apart, or you could go to the gym to maximize the function when things are going well.
SPEAKER_01Nicely put. Yes, that's correct. Avra made a very, very good point. So, neurofeedback is not just for people who are trying to fix something, but also for healthy people trying to improve their performance and their productivity.
SPEAKER_00I love that perspective. I actually never thought of it that way. I really like that perspective. So, so when my people were doing neurofeedback, they had to go to the office of a practitioner twice a week for months, which is hard. Not everybody can do that. And so, one of the reasons I wanted to talk to you guys is that this concept of having personalized neurofeedback, and I make that distinction because there are products that you can get that are like for anxiety and it's just sort of the same who trains things, but it's not you, it's the same for everybody, and those are less effective, right?
SPEAKER_02It's generic protocols.
SPEAKER_00Yeah, generic protocols, which is not as good in my in my understanding. But what you guys do is the personalized training operate condition for this specific person based on what you're reading remotely from this QEG product. And I think that's amazing.
SPEAKER_01Yeah, yeah, exactly. I um I recently, well, I think it was last year that I published a paper on this very topic. In fact, that um out of the box protocols, even in your feedback, you know, people you know tend to think, oh, I'm gonna uh this, for example, you know, depressed patients, I'm gonna use this protocol. No, you have to, as we say in science, you have to look at the data first, and then on the basis of your understanding of the literature, uh customize, uh tailor training programs for that particular patient for that particular set of data that you that you are observing.
SPEAKER_00Right. The simplistic, uh, the simplistic association that I make is you could say, Oh, I have a fever, so I have an infection, so I'll take an antibiotic. Yeah, you can't take a generic antibiotic, you have to take the antibiotic that works for the particular kind of infection that you have, right?
SPEAKER_01Yeah, this is simple. Exactly. Exactly. Or the example of insomnia in that we uh we just covered some in some patients. The there are some frequencies that are altered in other patients. Um with the other freak other frequencies. So you have to just can't plug them in using an out-of-the-box, you know, pre-made protocol simply because you read on the literature on PopNED that it works.
SPEAKER_00Right. You have to diagnose them and then make a treatment plan for them. That's what you guys do. Yeah, yeah.
SPEAKER_02Yeah. Yeah. Two people can have the same manifestation. I mean, they're not able to sleep, but the root cost might not necessarily be the same. Right. So using a generic protocol, you don't know which one you in one case, yeah, it might work, but on the other case, it could do the contrary. So it's what we do does differentiate of out of the box.
SPEAKER_01And uh feedback is such a wonderful therapeutic tool, as long as you know how to use yeah, and it's important to know to understand also, but uh through medicine in general, that it's not a univocal relationship between an imbalance, uh an EG imbalance and its symptoms. For example, um, an increase in uh um low frequency uh activity, EG activity, is seen in uh patients with depression and also in patients with TBI and the frontal regions, for example. Um or of course, TBI is very often linked to depression. And so you're probably fixing depression in those in those patients, but uh so it's important to uh to understand that uh EEG uh data must always be combined with uh other data, so other uh modalities, if you if you will. So symptoms, right? Symptoms from from questionners, um, and or unstructured unstructured interviews with the with the patient, or as we said, cognitive performance data. So you always want to know uh want to create um in your in your mind as a practitioner an association, get a story, a narrative of the patient before throwing a protocol.
SPEAKER_00For sure. This is how clinicians think, anyway, right? We don't we don't get an x-ray and start treatment without talking to the patient and hearing their story and then examining them both. So so let's get to the the nitty-gritty here. Let's say that someone says, okay, this sounds amazing. I have patients that I want to send, but I need to tell them how it works. So they go to their doctor and the doctor connects with you, or can the patient connect with you directly? And then tell me the things like how do they get the headset? How much does it cost? Like tell me how it works so that in case a clinician's thinking for themselves, or also for their patients.
SPEAKER_02We could work with uh either way, as long as uh we have the uh backup of the treatment physician. Okay, otherwise we see that the the lack of adhering to the program. So either the clinician could do it as part of his program, and everything goes through through the clinician. The clinician handles start the training, and we are at the back end of the doing the actual configuration of the protocols, analyzing the data, or the clinician can refer them to us.
SPEAKER_00So wait, I'm I'm gonna stop you for one second and then I'll let you finish. But I want to make sure I that I highlight what you said, which is if someone listening thinks, oh wow, I would like to incorporate this into my practice somehow, they could connect with you guys to figure out how to do that. But also if they said to themselves, I don't know how I don't want to deal with that, I just want to send my patients to you, that is also an option.
SPEAKER_02Yes, that's also as long as he's it's like in the mix.
SPEAKER_00So if a clinician is willing to engage with you guys, then they can just send their patients directly to you. So let's talk about that one for a minute. Say if a physician says, okay, I I'm not going to put this into my practice, but I really like this idea and I want to send people to you. And I'm willing to follow the patients, but I want them to have what you have. How does that work? How much does it cost? What does the patient have to do so that the physician can tell the patient?
SPEAKER_02Okay, there's there's the basic kit, which is the headset, the electrodes, and the conductive space that you need to place the so the uh movable electro can can stay, let's say, glued to the to the score. Okay, that it's around uh let's say 350 more or less.
SPEAKER_00$350. Okay.
SPEAKER_02Yeah, and that kit will serve you with uh the period, what we call the core program, which is six months of training.
SPEAKER_00Okay.
SPEAKER_02And after that, since this is a reaction base uh through the app, they will pay us a monthly fee, and that is uh in our case, that's $450 a month.
SPEAKER_00$450 a month.
SPEAKER_02And that includes assessment. Francesco usually put uh an assessment more or less every month. So every month we go over uh we take another snapshot of how your brain is doing. Okay, okay. So that's included. We're always there for them whenever they need us.
SPEAKER_00For that first six months, so they buy the headset for $400, $350, $400. And are in that first six months they're starting to train. Are they also paying $450 a month during that time or no?
SPEAKER_02Yeah, every month, every month it's a $450.
SPEAKER_00I got it. So starting, so they buy the headset, then $450 a month. And how long would they expect to need this? I know you can't say because it depends on what they need help with, but just generally giving them an idea.
SPEAKER_01You can't promise, of course, you can't make any any any promises. Six months, a year, six props, six months at least.
SPEAKER_00Six months at least. Okay.
SPEAKER_01Yes, that's why we call it the core program.
SPEAKER_02Neurofeedback is not a linear outcome. But if you start here at the end, you will be here, but it's not a linear thing.
SPEAKER_00Right. So people could decide, I want to stay longer, I've gotten some success, I want to get more, I'll do more.
SPEAKER_01Well, they can resume anytime, and they can keep, of course, the equipment, the owned equipment. They don't have to give it back to the bottom.
SPEAKER_00So so do people tend to keep the benefits that they gained? So if they weren't sleeping and then it worked and now they're sleeping, do they keep that, or does that go back to how it was before if they stopped trading?
SPEAKER_01We know from research from uh from research that um that the uh the benefits of neural feedback are long-term. So that's great. Of course, you know, I can't generalize uh because there's so many setups, so many pieces of equipment and so many studies, uh, but uh generally speaking, the the results are long lasting.
SPEAKER_00That was the experience in our family. Everybody that got a benefit kept the benefit. It didn't reverse. I wanted to give some perspective on the cost. When I took family members for neurofeedback into the therapist's office, it was a little bit over $100 each time, but we went twice a week, every week for months. So that was about $250 a week. So $1,000 a month, actually. So even though it may sound like a lot, really, if you go to a neurofeedback therapist, this is still less expensive. And can people submit to insurance? Do you know? Do they have any hope of getting anything back if they submit to insurance?
SPEAKER_02Yeah, yes, I know. Usually insurance don't cover neurofeedback. Okay, but there are some that do. Uh, we have had cases that do. Uh, also, what we have seen, if you if you as a clinician do neurofeedback as part of your program, a program that you have developed as uh psychiatry, then being included in the program, then you might be able to get the patient requires.
SPEAKER_00Got it.
SPEAKER_02But as a standalone, there's not that many uh, let's say, conditions that neurofeedback is approved by insurance companies.
SPEAKER_00How about health savings accounts? Can people use their health savings account? I would think yes.
SPEAKER_01Yes, some insurance uh uh companies cover for assessments, but not neurofeedback, at least part of the uh of the service and we cover it by health insurance.
SPEAKER_00And then how do people find you if they if they are inspired by this and either they themselves want to try it out, or they like this idea of somehow integrating it into their practice and they want to learn about that, or they want to send people to you, where do they find you to?
SPEAKER_02I guess the best way is through the website. They could write us and we will answer.
SPEAKER_00What's the website?
SPEAKER_02www.the word hello h-e-l-l-o, followed by neotherapy.com. Hello neotherapy.com.
SPEAKER_00Hello neotherapy.com. And I'll put this in the show notes as well.
SPEAKER_01In Spanish and English.
SPEAKER_00In Spanish and English. Oh, great.
SPEAKER_01Bilingual, of course, um Alvar speaks Spanish. Um, so and the the website is in both Spanish and English.
SPEAKER_02And so we will put Italian as well.
SPEAKER_00Ah, fantastic. That's great. Wonderful. I am so grateful to you both for this really fascinating conversation. Thank you both for being here.
SPEAKER_01Thank you, Didi. You're very welcome. Thank you for having us. Great, great chatting with you.
SPEAKER_00Indeed. All right, everybody. Thank you so much for listening. You should definitely go check out their website. This is sort of something that you should think about for your own practice if it fits, maybe for yourself and your own family, and also for patients. So please go learn about it because nerve feedback is important. I think it's not talked about enough, and the opportunity for patients to do it from home is really life-changing. So thanks so much for being here. Forward this to a friend who you think might be interested, and I'll see you next week. Bye. This podcast is brought to you by the Integrative Palliative Institute. Visit our website, integrativepalliative.com. There you can access physician and clinician training, well being coaching, free downloads, and other cool stuff. And feel free to connect with me on LinkedIn and share your favorite episode with a friend.