Ep. 71: Neurofeedback: A Discussion with My Personal Counselor

In this week’s episode, we are joined by Betsy Ezell, LPC, BCN, the Director of Neurofeedback and Lead Therapist at Heritage Counseling’s location in Austin, Texas.

Today, we’re diving deeper into the potential benefits of Neurofeedback, which can include impacts on behavior, attention, mood, trauma recovery, and more.

Highlights:

• – Explanation of what brain waves are and how they correlate with our experience
• – Defining a target for “optimal” brain function
• – How the Neurofeedback process works
• – Personal experiences, issues, and areas of progress

Tune in now to learn and expand your understanding of Neurofeedback and the brain!

You can find Betsy and her clinic at www.hertiagecounseling.net

Read the transcript:

Garrett Salpeter (00:03.36)
Hello, New Fit Nation. We are back here on the undercurrent podcast. And this is our second podcast on the theme of going upstream. Looking, we’re talking about the nervous system, as far upstream as we can go is the brain. And today we’re gonna talk about neurofeedback. And we’re gonna do it with a special guest, Betsy Ezell.

who is the Director of Neurofeedback at Heritage Counseling based in Dallas, but they have an office here in Austin. And I have gotten to know Betsy pretty well because she is my counselor and has been guiding me through neurofeedback. So we’re gonna be talking conceptually about what it is and also get to dive in and share a little bit of personal experience as well. So Betsy, thank you so much for joining us.

Betsy Ezell (00:52.42)
Thanks for having me. I’m excited to be here.

Garrett Salpeter (00:55.404)
Can you please just share a little bit about your backstory as an LPC and how you got into neurofeedback just so everyone listening knows where you’re coming from?

Betsy Ezell (01:05.174)
Sure. Yeah, so I…

When I was growing up and in school, I always wanted to go either into mental health or medicine. Ultimately, I chose mental health because I liked that I felt like it was a more holistic way to work with individuals and families. And then really early in graduate school for counseling, I learned about nerve feedback. Some folks were rotating through my graduate school program. I learned about nerve feedback and it seemed like to me the perfect marriage between like the harder science.

of medicine and the softer science of mental and behavioral health. And so in conjunction with my graduate didactic courses, I also started learning neurofeedback and working in clinics and in my practice now do both neurofeedback and clinical counseling.

Garrett Salpeter (01:59.576)
Awesome. And as we’ve talked over the months, you told me that before you being here at Heritage in this current setting where we’ve worked together, you were working in some other interesting settings with Medicaid patients, a lot of trauma. Can you just talk a little bit about some of those other experiences you had as well?

Betsy Ezell (02:17.064)
Mm-hmm.

Sure, yeah, so after graduate school, I worked in a neurofeedback clinic for a little while, and then also worked in residential and a day treatment facility for adolescents who had experienced really extreme trauma and also had some legal trouble. And then after that, I ended up taking a job in Northern Colorado at the largest, actually community mental health clinic in Northern Colorado, and they serve exclusively

And so at that point they had invested quite a lot of their training allocated dollars and many of their staff or many members of their staff to offer neurofeedback. And so I took a job with them and helped them refacilitate how they were offering neurofeedback, help streamline their programming and make it more accessible for…

like on the clinician side for clinicians to learn and feel confident in offering the service, but then also for clients to access as well. And it was a really rewarding process because Colorado Medicaid obviously is state funded. And so there were a lot of eyes on whether or not this program could be successful at this scale that we were at. And ultimately many of our program standards were adopted or

used by the state or looked at by the state as the quality standard for neurofeedback in the state.

Garrett Salpeter (03:50.016)
That’s awesome, very, very cool. And thank you for sharing that. And I’m so excited to get into the mechanics of neurofeedback and brain waves, but to frame up the conversation for people, can you talk about some of the benefits and why people might seek out neurofeedback treatment in the first place?

Betsy Ezell (04:11.362)
So many of the families or folks that we are talking to often that are considering neurofeedback are often coming from either a perspective where they’re looking to avoid medication for the treatment of a behavioral health or mental health symptom. So neurofeedback got its start in the US really at looking at focus and attention. The Department of Defense was doing some work on how to sustain attention with pilots.

our largest and most robust body of research is folks that are looking to find support with focus and attention issues and there’s some good research that neurofeedback can be as useful and helping folks with focus and attention issues as medication can be.

but without the side effects. So lots of families and individuals are interested in NERPPEC as a service to avoid medication. Other families and individuals are looking to maybe decrease or totally eliminate medication from their treatment options or treatment regimes. So we talked to quite a lot of families that are trying to get off meds. Also some individuals and families that have had some improvement on medication, but not total improvement on medication.

for something to help bridge the gap there. And then also really rapidly growing part of our field is folks that are athletes or are

working pretty stressful jobs or highly demanding jobs that are looking for cognitive benefit or just like cognitive excellence. So a lot of individuals find that they can improve their memory and they can improve their sleep and they can improve the clarity of their thinking with neurofeedback and that’s really attractive to folks that really want to use their brains well.

Betsy Ezell (06:09.062)
From a mental and behavioral health perspective, we tend to see lots of folks with focus and attention issues, anxiety and mood disorders, sleep issues, some head injury recovery, and research is really growing in our field for efficacy with autism spectrum disorders as well.

Garrett Salpeter (06:27.648)
So there’s a broad range and I’m not surprised. I don’t think anyone would be surprised to know how broad the applications are because when you’re working with the brain, the brain is, you know, controls everything and has such far reaching influence that it’s such a powerful target here to work directly with the brain. So I imagine everyone listening probably heard at least one or two things in there that they or a family member or a loved one, you know, could benefit from. So hopefully we’ll be leaning in

more as we progress through our discussion here. Let’s shift to some of the mechanics of neurofeedback. When I did my test or if someone goes in for their testing, they start out wearing this cap with electrodes and you’re measuring brainwaves. You’re going to see electrical activity in the brain. Can you tell us what actually are brainwaves?

Betsy Ezell (07:16.175)
Mm-hmm.

Betsy Ezell (07:24.786)
Sure. So we’re all really familiar or many of us are really familiar with the conversations that we have about neurochemical communication in the brain. So we talk about

serotonin or dopamine or epinephrine, right? And we talk about adrenaline and the chemical communication in the brain. And so the way that the chemical communication happens, if we kind of go back and remember when we learned about how neurons communicate, is that one neuron can release a neurotransmitter or some of these chemicals, and then another neuron or group of

Betsy Ezell (08:07.704)
essentially is turning on and off those neurons. It’s a little bit of a basic explanation, but the on and off or the polarization and depolarization of those neurons creates a current that can be recorded. So brain waves are actually called electroencephalogram or EEG.

And we record it doing the same, it’s the same science as EKG. So EKG, we’re looking at the electric output of the heart. EEG, we’re looking at the electric output of the brain. And so that current is created by that neurochemical communication in the brain.

Garrett Salpeter (08:46.88)
And why is it that we get these, and we’ll get into what the

you know, beta, alpha, theta, delta patterns are, why is it that those neurons go off in sort of a synchrony or a rhythm and you get these waves? Is it, I kind of think of it from an electrical engineering background, I sort of think of it as like the timekeeping mechanism on a central processing unit, the CPU of a computer. There’s sort of like this background timekeeper going and everything happens on cycles like that. Is there any element of that in the brain?

Betsy Ezell (09:18.477)
Mm-hmm.

Garrett Salpeter (09:23.578)
or is that just kind of a silly way of looking at it? But what is the, why is there this kind of wave or rhythmic nature?

Betsy Ezell (09:32.906)
It’s a good question. I think the way that you’re thinking about it is appropriate. It’s really the brain working to get its job done. So there’s a lot of tasks that the central nervous system and the brain are in charge of kind of executing throughout the day. And so the nature of that kind of communication across the cortex needs to be happening all the time, all of the lobes and the different kinds of neurons even that are in different parts of our brain.

brain and even like different layers of the brain need to communicate with each other to get their jobs done effectively.

Garrett Salpeter (10:15.136)
And one of the things that you told me, and I’m officially giving you permission to break it up and talk about my brain here, so no concerns. But one of the things that you told me was that my brain, and I have some issues we’ll get into, so this is not about bragging by any means, but one of the things you told me was that my brain works one or two hertz faster than the average for my age.

Betsy Ezell (10:35.286)
I’m sorry.

Garrett Salpeter (10:44.812)
And so is that there’s sort of like this background, approximately 10 Hertz activity, you know, mine was maybe 11 or 12 Hertz cycles per second. So is that sort of the background timekeeping function? And then the other, you know, to get to Delta, go down to Delta or up to Beta is sort of a deviation from there. Is there any sort of like baseline rhythm or can you talk to us about what that means when you told me about that sort of baseline speed?

Betsy Ezell (10:45.076)
Mm-hmm.

Betsy Ezell (11:13.73)
Sure, so speed is a super important metric that we look at when we talk about how a brain is functioning, but it also tells us a lot about the capacity or the ability of a brain as well. So when we talk about baseline speed, often that is found within the alpha frequency, which generally is measured between eight and 12 hertz or eight and 12 cycles per second. And that…

particular rhythm, the one that we’re talking about, referring to that dominant rhythm, typically in the back of the head, oftentimes we’re gonna call that the posterior dominant rhythm, is generated from the thalamus. And the thalamus is known as the pacemaker for the brain. Kind of keeps us ticking, kind of keeps us moving. And the thalamus, I’m not sure if we really wanna get into these kinds of specifics, but it’s a subcortical structure. So it’s kind of tucked under the cortex, so that pink like.

fleshy part of your brain and that alpha rhythm, the speed of that, if we’re too slow.

right, then we may not be able to interpret information as quickly as we’d like to. We may not have the ability for complex cognitive analysis. We may need longer times for processing information of all kinds. And then there’s an average that the average adult, the average child will function at. And that rhythm really shows us that there’s a desirable or adequate brain speed.

for typical functioning. And then when we have elevated speed, typically we’re talking about folks that may have a higher IQ or a more a higher ability to interpret and understand complex information.

Garrett Salpeter (13:06.988)
Okay, that’s interesting. I don’t know that I knew or perhaps you told me and I forgot, but I didn’t realize that timekeeping mechanism was in the thalamus. And we think of the thalamus as being the primary sensory relay station of the brain. So that’s interesting that what speaks to perhaps one of the core functions of the brain is, of course, as being

Betsy Ezell (13:22.08)
Mm-hmm.

Garrett Salpeter (13:32.992)
processing environmental inputs, right? I mean, obviously we know that’s a big deal, but that struck me as interesting. So no further comment on that other than just calling it out there.

Betsy Ezell (13:35.948)
Right?

Garrett Salpeter (13:46.06)
Can you, I want to ask what we can learn about a person by observing their brain waves. What sorts of things you can learn about, the things you talked about earlier about their mood and behavior or cognitive abilities or different things. But before we do that, can you, we’ve mentioned these categories of brain waves. You just talked about the alpha and the frequencies. Can you just define those for us? So we have that vocabulary set and then we can get into what they actually mean.

Betsy Ezell (14:12.77)
Sure. So we, in effect, in an effect to try to better understand functioning and brainwave activity, the general community at large has denoted specific frequencies to have specific names but also be generally associated with specific types of functioning. So the ones that you’re going to hear most often are delta.

which is our slowest brainwave, typically and most often categorized from about one to four hertz. The second being theta, theta typically between four and eight hertz or cycles per second, alpha between eight and 12. And then we’ve got beta, which we commonly break down into three different categories. So low beta between 12 and 15 hertz.

mid-beta between 15 and 18 hertz and then high-beta typically we’re going to measure that between 22 and about 36 hertz and then the last one called gamma which we typically measure any between like 40 and above cycles per second

Garrett Salpeter (15:24.56)
Okay, so thank you for that. And now that we understand those ranges, can you tell us generally what we can learn? I know it’s very open-ended because there’s a lot you can learn depending on that sort of thing. But when you get this EEG, you go through this EEG process and you’re measuring the activity, you’re finding…

amounts of activity in these different ranges. You’re finding some delta, some theta, some alpha, some beta activity in certain areas. And what does that mean?

Betsy Ezell (15:51.95)
Thank you.

Betsy Ezell (15:56.962)
It’s a so the answer varies just a bit because location matters. So the presence of a specific brainwave in a specific area of the cortex can have a really specific indicator to something. But generally speaking.

Delta is a brain wave that’s highly associated with sleep, also really associated with healing. So if we look at a brain and there’s significantly excess amounts of Delta, then what we would expect to see, we get curious about head injury or even some sort of like indicators of like metabolic.

anomalies or difficulties. Also, sleep and healing most often with Delta. Theta is often known as a fairly creative brainwave. It also in excess can really be indicative of folks that may be a little bit daydreamy or have difficulty sustaining and maintaining attention.

Betsy Ezell (17:06.016)
posterior in the back of the head where we talk about maybe, maybe like stubbornness or difficulty feeling as grounded as we’d like. Alpha is kind of that

like eight to 12 hertz. We talk a lot about alpha because the speed of alpha is important and the power of alpha is also really important. I use a little bit of a silly anecdote to talk about alpha a lot, but if your brain was a car, alpha would often be considered your neutral state.

but also your gear shifter. So alpha does a lot for us when it comes to flexibility, when it comes to feeling calm and regulated, even like grounded in our natural kind of common state and excess we can, we talk about sometimes if there’s too much excess of alpha, we talk about maybe dissociation, difficulty with groundedness, difficulty with both focus and attention, in deficit, often difficulty with relaxation, maybe anxiety.

and trouble feeling regulated and calm.

Low beta that 12 to 15 Hertz range is a brainwave that we all often really like. We typically really like when we’re in a low beta state. We’re typically very grounded, very present. We’re able to get a lot done. We’re able to accept information we can learn, we can perform, we can present really well in this state, but we’re not often stressed. We’re in like a highly functioning kind of ideal state.

Betsy Ezell (18:41.522)
And then our higher beta frequencies, we need them for performance. So for academic performance, professional, athletic performance, we can transition into a state where our brain has more of those higher betas, so the mid and high betas, it helps us a lot from a performance metric. We can get a lot done, we can get ourselves to safety if we need to, we tend to be able to like physically get managed a lot.

or if we stay in that state for too long, we talk a lot about anxiety and stress. Talk about sleep difficulty and overactive nervous system too activated.

Garrett Salpeter (19:23.968)
So that, I think that makes a lot of sense and hopefully everyone’s following along about what each category of brain waves, each of those frequency ranges means.

And then how on this spectrum, where do most people fall in terms of their brain generally globally having a dominant frequency at any one time versus different lobes and different parts of the brain each having different frequencies that could be much different. One could be at gamma, one area of the brain could be at gamma while another could be in alpha and there’s a big difference between them. Where do people generally fall in that range of global?

Betsy Ezell (19:59.122)
Mm-hmm.

Garrett Salpeter (20:03.374)
uniformity versus local differences.

Betsy Ezell (20:07.318)
Yeah, so we all have all of those frequencies at all times, where we tend to run into sometimes challenging presentations or situations that are difficult for us is maybe we’re excess or deficit in a specific brain wave in a part of our brain that really helps us execute certain tasks. And that varies really significantly, but at all moments of…

of our days, we have all of those brainwaves, they could all be recorded from the scalp. It is who or which brainwave has the dominant power that most significantly can affect us moment by moment.

Garrett Salpeter (20:56.62)
Okay, that’s a good explanation. I think that was an even better answer than the question that I asked, so thank you. So, so.

Betsy Ezell (21:04.107)
No.

Garrett Salpeter (21:09.96)
I think that segues naturally into this notion of what a target or if you can say optimal or ideal brain looks like because you talked about certain areas perhaps could be under or over working or have deficits or excess of certain brain waves in that area of the brain.

So let’s talk about that for a moment. Can you tell us what you use as a target or how we define optimal so we know what the goals are and where people, if they’re deviating from a standard, what that standard actually is?

Betsy Ezell (21:45.966)
Sure. There’s a couple of pools of information that we use to help us determine what an individual’s brainwave functioning is looking like. One is that we can compare an individual’s brainwave activity to a database. We call it a normative database, but we can compare to this database. And then we get maps back that show us what parts of the brain might be over utilizing or under utilizing brainwave resources and in what way.

data set or that normative data set, we use one specifically in our clinic that’s comprised of individuals who have been considered to have the ideal brainwave functioning. And the inclusion criteria to that has been quite high. So no history of neurological disorder, no history of psychological disorder, no history of head injury, and then met or exceeded all developmental

Betsy Ezell (22:45.872)
milestones across the lifespan. And then there’s also even been some criteria for immediate family members of the folks that were considered into the inclusion here. So what we get back, if we compare an individual’s brain move activity to this database, we can see where in the brain and in what frequencies we’re deviating from the ideal by age group. So there’s different age groups per.

the database. And so we can see based on what we know to have been at least successful in the database, we can see where we’re deviating from there. So we can compare an individual to the ideal.

But we also do some analysis of data that compares an individual brain to itself. So we look at ratios a little bit more. So what parts of the brain are over utilizing and under utilizing brainwave activity based on their own baseline of functioning, which was a little bit more complicated. But we…

But sometimes if you look at somebody who’s exceptionally high functioning, then a comparison to the ideal may not be as helpful. We might need to look at their brain and just compare it to its own functioning in different states. So typically we do both with all of our clients. We’ll compare to the database, but we’ll also just compare them to themselves.

Garrett Salpeter (24:16.044)
Okay.

Is the database, is that essentially what I would refer to as a balanced brain, as opposed to, if you think about someone who’s a savant, you think about the beautiful mind, someone who might be an expert in mathematics or have some virtuoso skill, but have deficits in other areas, is that

Betsy Ezell (24:28.014)
Thanks for watching!

Betsy Ezell (24:33.464)
Hmm.

Garrett Salpeter (24:47.656)
describe what the database would be describing as sort of the optimal brain.

Betsy Ezell (24:54.014)
And that’s a very big question. Um, no, for the, for the purposes of the specific database that we use, no, because the goal for them was to find the highest yet normal functioning brain. When we talk about the brains of maybe a savant or exceptionally high, um,

Garrett Salpeter (25:12.481)
Mm-hmm.

Betsy Ezell (25:19.25)
folks with exceptionally high IQs or exceptionally high capacity, they’re atypical just in a different way. And so they wouldn’t be a really fair comparison for us. But there is some really interesting data about folks that are typically able to achieve more than the typical person.

Garrett Salpeter (25:43.584)
Could you like dial someone’s, dial up someone’s math skills or dial up someone’s musical ability? I mean, can you get that like specific in terms of skill acquisition or almost like the matrix, like you’re installing an ability in somebody?

Betsy Ezell (26:04.591)
No, although I do think that neurofeedback would be much more popular if we could do that. No, there is some, so what we know about speed, right, and speed is pretty highly correlated to our ability to comprehend information to…

cognitively to be able to do complex cognitive processing and things like that. What we know about speed is typically you get what you get.

So what we’ve got developmentally, what we’ve established, we kind of get it. There has been some data and some instances where folks have done neurofeedback training and even some forms of stimulation training where their speed has gotten faster, but not dramatically faster. Typically that’s a genetic thing that we’ve inherited.

that we’re not able to really significantly manipulate.

Garrett Salpeter (27:07.276)
Okay, so in terms of this, perhaps a little bit of a detour on the idea of downloading into somebody specific skills or something, would it be fair to say that…

Betsy Ezell (27:12.319)
Yeah.

Garrett Salpeter (27:19.496)
that brain speed and communication is sort of the foundation. You want that to be healthy. And then once it is, then someone can practice and learn skills and retain the information and adapt and stuff like that. But it’s sort of the foundational building block or the foundational level upon which you would then build those types of skills.

Betsy Ezell (27:40.074)
Yes, absolutely. But it also helps us have a really good understanding of what a brain is capable of.

Right? If naturally an individual has much slower speed than what is considered to be desirable, then we can work to understand and maybe even shift our expectations for an individual as to what would high performance look like for an individual whose natural speed is lower than the ideal and similar for someone who’s exceptionally fast. We would maybe increase our

of their ability.

Garrett Salpeter (28:21.94)
We’ve seen some pretty cool and really incredible adaptations in terms of functional improvements for people with different types of traumatic neurological injuries or neurodegenerative conditions. So I’m wondering if it’s an experiment we can do together to see if we could find ways perhaps with the newbie or other approaches to reliably increase that.

underlying brain speed. I wonder, you said you’ve seen glimpses of it with neurofeedback training, but there doesn’t seem to be much there yet. I just want to plant that seed that perhaps is something worth looking at.

Betsy Ezell (28:52.433)
Mm-hmm.

Betsy Ezell (29:00.79)
That certainly would be.

Garrett Salpeter (29:06.772)
All right, so I love talking about this. There’s a few different directions I wanna go. Let’s shift over to trauma for a moment. I did an episode probably in the last five to 10 here talking about trauma really influenced strongly by the Body Keeps the Score, Dr. Bessel van der Kolk’s book and

talked about, it’s a really important topic. It’s something that finally is getting recognition and we’re able to help more people. But one of the things that he mentioned was neurofeedback. And that was initially what got me interested and excited to try this out too, is definitely one of the influences there. So can you talk about how trauma might show up in an EEG? What…

what are some of the signs you might see that someone has experienced trauma?

Betsy Ezell (30:10.352)
There’s several indicators that we know of when we look at an EEG or even a QEG that we know to maybe consider that the brain or this particular individual has experienced significant trauma.

One of those is some atypical functioning in the alpha frequency in the back right area of the cortex. So that like posterior right side area typically we see some discrepancy in the power but also variable speed in that back right area. Also there’s a couple of other like

more mild indicators that sometimes we might see in the frontal cortex. Occasionally we might see excess in alpha indicating that somebody is not feeling particularly grounded and maybe not feeling incredibly connected to themselves. We can even go a little bit deeper. So with some of the newer…

technologies in the field, we can look really specifically at certain functional areas of the cortex. So the neurofeedback field tends to lean pretty heavily in this area on specific broadman areas. So there’s broadman areas that are most often subcortical. So a part of that limbic, more emotional system that we can look at and see atypical power allocation,

Betsy Ezell (31:50.388)
between certain areas of the brain. There’s some kind of specific indicators for trauma and even the volume of information shared between groups of neurons. We call those coherence and phase. There’s some coherence and phase dynamics that can be pretty specifically notable in folks that have experienced a lot of trauma.

We also like to take a look at the temporal lobes a fair amount as well when it comes to traumatic experiences. A lot of those areas are really close to the limbic system and the limbic lobe, but involved a lot in emotional processing, memory and things like that.

Garrett Salpeter (32:28.364)
Okay.

So, so far we’ve talked about what brainwaves are, we’ve talked about where, how different presentations or the presence of brainwaves in certain areas can, like you just mentioned, indicate past experiences of trauma or it could be relevant to mood, behavior, focus, attention, memory, cognitive performance, other traits, stuff like that. So, so I think, I think we’ve established

the importance of identifying these brainwaves, what they mean. We’ve talked about the standards we compare them against. So let’s transition now to treatment and how we do the actual neurofeedback sessions and how we help guide the parts of the brain that are over or under active or have the excess or deficient amounts of certain brainwaves towards that target, that goal state. And this is really

fascinating because it’s not at all what I expected the treatments to be like. When I go in there for my treatments, I sit there with, you know, sit in a chair with, with some electrodes over monitoring the areas that we’re looking to train on that particular day and I get to watch a show and it’s really fascinating. So I got to watch a couple of Netflix documentaries that I’ve been meaning to watch and couldn’t find the time. So it was actually quite lovely. Um, but.

Betsy Ezell (33:51.681)
Yeah.

Garrett Salpeter (33:56.86)
the screen will change. So it’ll be, my understanding is that if my brain is in the state that we’re choosing to coach it into, the screen will appear normal. And if my brain deviates, the screen will actually compress in so it’s not, the image isn’t filling the whole screen, it’ll kind of shrink. And it might go gray scale, black and white instead of full color. And it’ll sort of nudge my brain back into

the state that we’re trying to train. So can you talk to us about how that process works? And hopefully people can at least visualize what it’s like, but can you tell us what’s actually going on during those sessions?

Betsy Ezell (34:37.77)
Yeah, so Effectively what we are doing is operating conditioning. So we take a look at brain map data or QEG data and we can, based on a lot of research that has been done, we can know that if we target specific brain waves in certain areas of the brain, we can work to help increase functioning and decrease negative symptoms in those areas if we target those brain waves. So when we have…

individuals come in for training sessions, we’ll place sensors on the targeted areas of the brain that we’ve identified, and then we’ll monitor the EEG. On our screens, we’re always monitoring EEG activity, and then we set specific thresholds. So if we’re targeting, for example, an individual that might want to improve focus and attention, not at all saying that this is Garrett, but if for somebody that wanted to increase focus

we might be training down theta in the prefrontal cortex and increasing that low beta power in the prefrontal cortex as well, looking to help the brain be more alert, more engaged, and sustain attention in a more fulfilling way. And so for clients, they’ll come in, we’ll place sensors on the scalp and we’ll monitor that theta and low beta activity. And every time that theta decreases below our threshold, clients earn a positive reward.

And every time that low beta goes above the threshold that we’ve set, clients also earn a positive reward, as you’ve said, Garrett, right? Oftentimes folks, when they come in, they choose to watch a TV show or movie. There’s also some games that we can use. They tend to be less popular in our practice, where if a client is achieving the positive reward, then their show will be full screen and full color.

And if they leave that desired functioning zone, if they’re not achieving the thresholds that we’ve set, the show will zoom out and gray out. And over time, the brain will learn that if it continues to maintain the pattern that we’ve set and it continues to achieve those thresholds, then it gets more of the positive reward. And as we continue training,

Betsy Ezell (36:53.354)
and the brain will learn if it maintains that pattern outside of the office, then we function more efficiently and our symptoms have decreased. So it’s important. A really important tenant of neurofeedback is the consistency of training. So it’s a twice a week appointment that typically lasts for several months, so typically 10 to 20 weeks of a time commitment, um, to, to effectively teach the brain to consistently function with those brain wave patterns.

to improve functioning and then once the brain has learned those patterns it will maintain them ongoing.

Garrett Salpeter (37:30.404)
I’m a testament to that schedule because I did that for 12, 13, 14 weeks or something, and now I’ve been able to wean back to once a week. There we go, so it’s maintaining. I was surprised when I did this. I was expecting when I came in for treatments to have it be more like.

Betsy Ezell (37:42.232)
Hmm?

Garrett Salpeter (37:54.612)
you know, beeping sounds or flashing lights or things where it would be more obviously in training certain frequencies. And I was surprised that I get to watch a show and that it happens this way. And I think your description was great. And that makes sense. You know, the operant conditioning, the reward and the, you know, punishment essentially for the brain. Is there any sort of explanation that you can provide as to why that

is more effective than something that might more directly entrain brain rhythms? Is it because you’re focused on the show and you’re more alert and you have a greater window of neuroplasticity or is it something else? What’s your thinking there?

Betsy Ezell (38:27.035)
Mm-hmm.

Betsy Ezell (38:35.566)
That’s a good question. And we can include in our training more auditory feedback. Some clinics will even include tactile feedback. Maybe they’ll have a stuffed animal that vibrates when a specific brainwave is achieving the thresholds that it has set. But what’s difficult always about any kind of conditioning, so operant or classical conditioning,

has to be engaging for the subject and we need to be able to maintain and sustain some sort of attention and also desire for the feedback. So auditory feedback is very, very popular in the field and there are clients that we actively use auditory feedback with now in addition to visual feedback. But what can be complicated about

that particular kind of feedback is that individuals may find it particularly annoying. And then it works actively against what we’re trying to do. So if we’re able to be successful with just visual feedback, that’s always where we start because we want there to be a desire to complete the training from the

from the client or the subject. And we also want to sustain their attention. We don’t want them to find it annoying. And so there’s a balance because the science of conditioning and entrainment says like the most specific we can be is the best, but often in that case is with humans, we also have to make sure that it’s not frustrating to the client because then we’re switching their emotional state, which really affects the state of the EEG.

Garrett Salpeter (40:23.624)
I think that’s a great explanation. Thank you. And I’ll share more about my experience, but generally it does seem to be working at least in my N equals one experiment. And I know you have research with much larger populations as well. Let’s talk for a moment about, when I got my report from you, you recommended doing neurofeedback and also some mindfulness, meditation and HRV training.

those also as complementary additional interventions or strategies and how they can influence the brain and help us move towards that goal of a quote unquote optimal brain.

Betsy Ezell (41:05.322)
Yeah. So, so at its core, neurofeedback is a really specific, complicated, higher tech way of helping the brain learn how to regulate itself, and also how to be more flexible, right? And so meditation, HRV, and specific other like mindfulness practices also work to help the central nervous system calm enough.

so that we can be active participants in our regulation. So HRV may be a little bit differently than mindfulness or meditation, but we’re looking to help the central nervous system regulate enough and then us be an active participant in that to increase flexibility in the system, in our systems. If we talk about that from a brain-based perspective, and for the sake of my clinical work, an EEG perspective,

When we’re successfully meditating, we are actively in an alpha state, right? We have transitioned ourselves into an alpha state. And then as we continue to practice meditation in the moment, right? But also in the lifetime, we’re teaching our brain that achieving that state and sustaining that state is something that we can be an active participant in, which helps us access more.

Emotional regulation helps us access more groundedness. And so in a way, we’re teaching our brain that we can be an active participant in how we engage with the world. And we are effectively teaching more flexibility to our nervous system.

Garrett Salpeter (42:45.361)
Okay, okay, that makes sense. I’m actually excited to go back and listen to this recording again too. So I like that description. And to help this sort of, if it does, if it seems at all abstract or vague, I do want to share my own personal experience.

just to help this really land for people so you can see how it can have a real tangible effect. So I do for the last segment of our conversation here, want to shift to talking about my experience. And just to be clear, again, I give you permission to talk about my case, no HIPAA concerns there. But I wanna talk a little bit about the findings that you had with me here and…

Betsy Ezell (43:23.918)
Thanks for watching!

Garrett Salpeter (43:35.688)
One, I’m gonna read you a quote from my report, which is a little bit technical, but I’m gonna ask you to translate this into, you know, everyday speak, or just so we can kind of connect it with some of what we talked about earlier. So one statement, relative power metrics indicated a midline and posterior excess of delta, a deficit of theta, and an excess of beta and high beta at the midline. So we’re talking about the midline, talking about…

too much delta, too little theta, too much beta. Can you translate that into what does that actually mean for human experience? So, what does that actually mean for human experience?

Betsy Ezell (44:14.962)
Um, yes. So a relative power, tell me one more time, access in Delta, access in data, access in Delta deficit and data. And then what was the other one?

Garrett Salpeter (44:24.992)
Correct.

Garrett Salpeter (44:28.424)
and then excess of beta and high beta.

Betsy Ezell (44:32.362)
Excess and beta and high beta. Okay, so excess and delta across the midline, especially if the temporal lobes are involved. We’re almost always pretty curious about a history of head injury. We’re always gonna lean into that. We’re gonna wonder about that. If it’s incredibly significant, if we’re maybe talking three standard deviations above the norm and.

which maybe wasn’t you, but we’re just kind of always curious about head injuries. If it’s more mild, typically there’s been more time since the head injury. If it’s really, really significant, it might have been more recently. But oftentimes when we’re accessing theta across the midline, definitely in the temporal lobes we’re thinking about.

thinking about head injury. Also, if your eyes are open, if that piece of the report was from your eyes open, recording an excess of Delta when your eyes are open is often indicative of maybe low energy or increased fatigue during the day. So that can often, especially for adults, we can notice that where we feel tired or maybe even lethargic sometimes, or have difficulty engaging to the level that we want to engage all the time. Could be either of those. It could be a combination of both.

Garrett Salpeter (45:47.232)
So I don’t remember if that part actually, from the report, I can’t immediately tell if that was eyes open or eyes closed, but we definitely did talk about head injury and talked about the concussions I had when I was playing hockey growing up and in college and how even now, 20 years later, there was actually some lingering signs of that. So that definitely we talked about. So yes, please continue.

The next one was the deficit of theta.

Betsy Ezell (46:20.254)
And then it was combined right with an excess of beta and high beta, right?

Garrett Salpeter (46:24.204)
Correct, yep.

Betsy Ezell (46:25.226)
So this is a good example of location is important, but also what are the other brainwaves doing that’s really important as well. So deficits in theta often, we get curious about creativity. Are we able to come up with creative ideas? Are we able to feel really competent in solving our problems as well as we’d like for us to, maybe even some stubbornness when we’re deficit in theta, we tend to be curious about those things.

when it’s combined with an excess of high beta, then we get a little bit curious about maybe intense stress or even some indicators of anxiety or stress management difficulty, where maybe our focus is a little bit more external than it needs to be, and that it’s difficult to feel as connected to myself. So commonly folks that have that pattern can struggle with…

maybe overworking, that managing their stress, relaxing can be quite difficult when we’re excess and high beta and deficit and theta as well.

Garrett Salpeter (47:36.052)
Okay, so we’ve touched on a few of the things that I also have on my list that I wanted to bring up. One, you mentioned stubbornness. I don’t think I’m stubborn, but my wife would have argued the opposite position there. So perhaps you were picking up something there. And then…

Betsy Ezell (47:46.432)
Heheheheheheh

Garrett Salpeter (47:53.472)
that feeling of stress and anxiety and external focus. I can definitely relate to that and I’ll talk about how it’s changed, but I definitely, when you were telling me some of these things that you found.

You know, you said, I might think, I might wonder if, if you have this or that. And I said, oh yeah, that’s, you know, feel like you’re looking at my brain, right? You know, I feel like you can really see, see inside and tell what’s going on, but an intense stress and anxiety. And I just felt like sort of existential pressure. And for me, it was around the, you know, the, the success of, of our business of, you know, of new fit, right. And sort of the existential, I think there’s probably some of this.

Betsy Ezell (48:16.448)
Hehehehe

Garrett Salpeter (48:37.312)
for most or all entrepreneurs about that, like, are we going to make it? There’s an existential anxiety, survival-based thing. I felt that and that has dialed down, just to foreshadow some of what I’ll share when I share my experience, but that definitely resonates. Then that external focus too, and this is something that

I’ve known a lot about intellectually this notion of like controlling what I can control, focusing only internally, letting the outcomes and the external results of my actions take care of themselves. But that’s something that I’ve actually sort of embodied or internalized a lot more going through this. And now it sort of feels, instead of just being an intellectual construct that I want to, is sort of like aspirational.

It’s actually something that I can kind of feel in a more visceral sense now. So I’m glad you mentioned that. I also, you kind of mentioned it, but one of the things that you told me was the…

you found this workaholic pattern. So what does that mean? I think some of what we just touched on there, but what is that? When you talk about, you saw this ring of activity and you called it the workaholic something. What was that term? And can you just tell us more about what exactly that meant?

Betsy Ezell (50:06.155)
So, um…

Yeah, we informally in the field will call that the workaholic drive. But what we’re really recording or what we’re really looking at in that area is that there’s a piece of quite cortical real estate or functional real estate in the brain that runs kind of down the middle from the front to the back. It’s called the cingulate. And the cingulate does a lot for us and it’s got several different jobs. And in academic literature and especially in neuroscience literature,

front of the head has a lot to do with motivation, inhibition, planning and attention. The posterior cingulate has a lot to do with emotional regulation, groundedness and emotional awareness. And then your midline cingulate has a lot to do with…

with it helps kind of synthesize both the front and the interior and the posterior cingulate, but also has a lot to do with just sort of like our desires, our attention, our execution of things. And also there’s some, there’s some, there’s some, there’s just, there’s some jobs in the, in the midline cingulate that also has something to do with like challenging or really like engaging with difficult things. Some of that

work happens across the midline cingulate. So when we’re really excess in power in high beta right on top of the midline cingulate, we’re very curious about folks have a very difficult time turning off or leveling down into more relaxed, maybe accessing fun, accessing rest, accessing anything that’s not super challenging or anything that’s not kind of feeding that stress pattern

Betsy Ezell (51:53.96)
for it. So for example, an entrepreneur, right, who is worried about the success, who’s invested a lot into the success of their business. There’s a lot of other examples too, but for folks that have this particular pattern, it can be difficult to transition out of that and engage as fully with the other areas of life as well.

Garrett Salpeter (52:19.169)
possible.

beautifully said. And I think that we touched on the main findings there. So I’d like to share my experience for people to, again, just kind of help this land for people so you can see how it’s impacted one real person here in front of you. And I’ll share these

Garrett Salpeter (52:49.678)
share them, if not, no pressure and I can go on to the next one. But one of the things that I noticed was a reduction in that

sort of existential background, always on, sense of anxiety around the business. And that manifested in a couple of ways. One was, you know, I would sort of feel like a bit of an emotional roller coaster, right? Sort of go up and down with the performance of the business. And sometimes that’s in a day or a week or a month or a quarter, you know, based on.

how well we’re doing, it’s like, oh, it feels like, oh, we’re gonna be on top of the world, then one moment it’s like, oh my God, where are we gonna make it? And sort of that like overreaction. And I feel like I’m able to, again, I knew intellectually, I don’t wanna get too high or too low, but I would just observe myself doing it anyway. And now I feel like I have that just more neutral state where I’m less celebratory and excited when things go.

when things, when we have a good thing happen and also less down, less of that projecting out in the future when something bad happens, less of that saying like, oh my God, we’re doomed. This is the end. So I feel like I’m able to maintain a more neutral state and in that, you know, be healthier, you know, have a better perspective, healthier perspective, be able to make better decisions, be able to conduct myself in a better way day to day. So

I definitely have noticed that. I don’t know if you have any comments, Matsey.

Betsy Ezell (54:20.39)
I think it’s an interesting thing that you’re saying and for the sake of time, I’ll be really brief about it. But I think sometimes when you say like, I used to have that background on all the time, kind of like rolling loop, I feel like sometimes I hear folks telling me if I don’t have that, I won’t be successful.

to think is an interesting belief that we can have about ourselves sometimes. If I’m not constantly thinking about it, then I won’t be successful. I won’t be able to attend to it. And it’s not that, right? It’s just that your central nervous system has learned that it can effectively and efficiently level up when it needs to, if you need to address a problem or really get something done or actively engage with a problem that you’re capable of doing that. You can increase your arousal to that place

and then come back down to a more comfortable neutral state. And then you can increase and decrease your activation as you need to. So I think it’s excellent you’re experiencing that symptom improvement. I’m grateful to hear that. And for your brain, it’s a healthier way to function.

Garrett Salpeter (55:31.323)
and.

Thank you for that. I think that adds good additional context and discussion. Another example of that is that projecting forward, that led to more anxiety around decision-making. We just recently, in the last month, decided to hire a new person. I felt like in the past, I would have had a lot more fear of getting it wrong and projecting out and stuff like that.

you know, the downsides and what could go wrong. But I was able to do it more objectively and get input from our team. And some of the positive evolution here is, you know, building a team and having, having great leaders that I trust and that we can discuss things with too. So that’s certainly some of it, but, but my, you know, I can only speak to really my internal experience here. I felt like I was able to sort of detach from the outcome a little bit more and just make a more objective and clear decision.

with less of that sort of background anxiety. So another, just a more concrete example of that sort of same general discussion there. So I don’t know if there’s anything more to add because it’s kind of an offshoot of that general reduction of anxiety, but it was a cool example to just kind of observe that happening.

Betsy Ezell (56:50.65)
I think it’s excellent.

Garrett Salpeter (56:54.788)
Another thing that I noticed, we didn’t talk about findings related to like coordination and visual spatial awareness, but one of the things that I noticed, so we have a ping pong table in the upstairs. We recently got it in the last year in the studio, upstairs studio at our clinic just across the office park here. And we’ve had some epic ping pong games, really a lot of fun.

And I played growing up, we had a table in our basement. I grew up in the Chicago area where we had basements. We don’t have those here in Texas anymore, but don’t have them here. So I don’t have one anymore, but I’ve been getting to play again. And we started playing before I started neurofeedback. And when I started neurofeedback, there were a few weeks where I was doing neurofeedback sessions twice a week, and then I came back and played, and I felt like my movements were more crisp, more automatic.

more less of me having to think about it more of just sort of allowing it to happen. And Jack, one of the PTs here, he and I have had some epic games. So maybe he’ll, it’ll start coming in so he can, can beat me. Right. And then when he hears me talking about this, but that was an interesting finding. I, I sort of, I was playing and I was like, huh, this is, this is, you know, it’s subtle, but it’s noticeably different. So can you speak to a little bit about that and why perhaps

Betsy Ezell (58:05.107)
Uh huh.

Garrett Salpeter (58:18.396)
I may have noticed that and also we’re gonna extrapolate that for why that might help athletes and what, you know, with neurofeedback or why it might be beneficial for athletes as well.

Betsy Ezell (58:27.454)
Yeah, absolutely. So specifically for you and your training, one of your training sites is located just above the sensory motor cortex. And so as we’re working to regulate in the sensory motor cortex, as an our stated goals were to address anxiety, right or stress management, helping you feel more calm. As we train that area, we also increase low beta activity across

Betsy Ezell (58:57.508)
they notice an improvement in their coordination, even in their athletic ability, in their visual field also as well. We find that as low beta increases in that area, we find those improvements. It’s a super popular protocol also in athletics. We find golfers tend to really like it, football players tend to really like it, soccer and tennis players as well.

Garrett Salpeter (59:22.516)
Awesome. Thank you for that additional understanding there. And then the last thing I’ll share is that I feel like I, I mean, I’m not a monk by any means. I, you know, I still, you know, can lose my cool and stuff. You know, I’ve got, you know, got young kids and, you know, we’re managing all these different things between business and home life and everything.

but I do feel like I’m quicker to notice when I feel myself getting heated and a little bit more detached and almost able to kind of recognize it more objectively. And therefore that leads to me being better able to sort of talk myself down or coach myself into a more neutral, better regulated state and get there faster. So I would, you know.

have fewer moments of getting upset and saying things I would later regret or stuff like that. And I’m not perfect. My wife’s listening. I’m not claiming to be perfect by any means. I still have issues. But I have noticed that I feel like I’m a little just noticeably better able to identify and then kind of regulate and address those states when they happen. So I don’t know if you have anything to say about that. I imagine you probably do.

Betsy Ezell (01:00:21.366)
Yeah.

Betsy Ezell (01:00:41.286)
Yeah, and we hear that a lot when we do alpha training, right? I feel like I’m able to manage more, I’m able to see it more, I can objectively understand a little bit better emotionally. I feel like I’m able to manage in a more efficient or effective way. That is kind of our on-brand alpha training. It’s great that you’re experiencing it. It’s pretty common for folks that do that specific kind of training.

Garrett Salpeter (01:01:07.58)
Wow, I feel like an alpha male. Oh, there we go. There we go. I think anytime we can end a podcast with a dad joke, it’s a good podcast.

Betsy Ezell (01:01:09.874)
No!

Betsy Ezell (01:01:20.642)
Hahaha

Garrett Salpeter (01:01:22.796)
So as we wrap up here, some people listening to this are going to be local in Austin. So I wanna ask you for your website and how people can find you if anyone wants to reach out and inquire. But many people listening here in New Fit Nation are dispersed around the country or even around the world and other countries. So first for people who aren’t here in Austin, are there any associations or resources where they could find neurofeedback practitioners near them?

Betsy Ezell (01:01:52.21)
Yes, I think it’s important when you’re working with a neurofeedback provider that you’re working with somebody who has board certification with our kind of overseeing body. So you can look online, they’re called the BCIA or the Biofeedback Certification International Alliance. And they’ll have a list of folks that are on their website that have achieved board certification in neurofeedback or BCN.

And also you can often do a Google search for folks in your area that have a BCN and that will also typically populate pretty well. We’re local in Austin. We have offices here in Austin. We have also an office in Dallas and then in Plano. So we’re Texas and we’re called Heritage Counseling. Our website’s heritage counseling dot net.

Garrett Salpeter (01:02:42.284)
Awesome. Betsy, thank you so much, not only for coming on and sharing your knowledge with our audience here, but also the work that you’ve done with me and how you’ve helped me. And I’m a big believer. I’ve recently been able to get my wife and one of our daughters in to.

to try it out and we’re gonna do some neurofeedback with them as well and I’m really excited. I’m a big believer and I think that a lot of these things that people try to address, whether it be behavioral or cognitive performance wise or whatever the issues might be that a lot of what we do is addressing symptoms where this allows us.

least in some cases, to go up closer up to the root cause, really get that first domino in a meaningful way. And I appreciate the work that you’ve done to help me and upcoming here, some of my family members as well. And again, yes, thanks for being here. Thank you so much, Betsy.

Betsy Ezell (01:03:45.711)
Thanks so much for having me.

Garrett Salpeter (01:03:48.3)
All right, New Fit Nation, appreciate you tuning in, and we will see you on the next episode of the Undercurrent Podcast.