We sat down with Dr. Robert Reiner, PhD, BCN, BCB, Executive Director & Founder, and Brieanna Scolaro, LMSW, Director of Community Relations and Myndlift Program Coordinator, from Behavioral Associates of New York City, which has been providing comprehensive mental health care to patients for 30 years and is one of the leading clinical providers of Myndlift. Dr. Reiner and Ms. Scolaro shared Behavioral Associates' philosophy of patient care and their experience integrating Myndlift home neurofeedback into their clinical practice.
1) Tell us a little about your practice:
Dr. Robert Reiner - I opened up Behavioral Associates in March of 1988, making 2018 our 30th year in operation. We are staffed by approximately 15 psychiatrists, psychologists, and social workers with all levels of experience. Furthermore, we offer pre-doctoral and post-doctoral training experiences. We see approximately 300 to 400 patients a week, and are open six days a week.
We treat the full gamut of psychological and psychiatric disorders that are appropriate to outpatient treatment, including anxiety, depression, ADHD, phobias, character disorders and borderline personality disorder.
As innovators in mental health technology, we make it a priority to stay current in a rapidly evolving field. This allows us to provide the most effective treatments and diagnostic tools that are organic and without side effects. Our office specializes in utilizing Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT) alone or combined with Virtual Reality, Biofeedback, Neurofeedback and qEEG brain mapping. In order to provide the best care to our patients, we also have two psychiatrists on staff to provide medication management when deemed medically necessary. In 2017, recognizing the tremendous potential in home neurofeedback training, we began to offer our patients the opportunity to train remotely using the Myndlift home neurofeedback system.
2) How do you determine a treatment plan for your clients?
Dr. Robert Reiner – As the Executive Director, I personally meet with each new patient to complete the initial consultation and assign them to the appropriate clinician on our team, based on the necessary expertise. In order to put together a more comprehensive treatment plan, we combine information from the initial consultation with results from psychological testing, such as the MMPI-2 personality test, as well as neuropsychological testing (qEEG brain mapping). When providing in-office or at-home neurofeedback, subsequent qEEG brain scans are conducted periodically in order to track progress and update the treatment plan accordingly.
3) What do you think is the most challenging thing about providing neurofeedback?
Dr. Robert Reiner – I think one of the greatest challenges is how to explain to patients what they are supposed to “do” during the process of neurofeedback training. There really aren't words in the English language to describe the act of "letting go" that must be achieved when training with neurofeedback. Paradoxically, the harder one tries, the less likely one is to be successful. I like to compare it to the experience of falling asleep. You cannot make yourself fall asleep, you have to let yourself fall asleep - but you can definitely prevent yourself from falling asleep if you haven’t developed the right skills. In all these scenarios one has to let a separate process takeover.
So, in a sense, to be successful in neurofeedback the first step is to surrender a sense of control and rely on a process that is completely foreign to you. Like meditation, the goal is to get out of one's own way and not dwell on intrusive thoughts – which anyone who has ever tried to meditate will tell you is easier said than done. In a way, the goal of neurofeedback is to solve a distinctively unsolvable human problem, which is, to be completely mindful; this is a target that is never fully achieved.
4) What do you think are the major benefits of Myndlift?
Dr. Robert Reiner – Neurofeedback in general provides a powerful, non-invasive alternative treatment for most mental health symptoms. However, neurofeedback isn’t always accessible due to financial, insurance, or time constraints. In New York City, we are the largest outpatient center offering neurofeedback. But even in our office, patients don’t always have the availability to complete their training 2-3x per week. I've always believed that four 10-minute neurofeedback sessions every other day are far more powerful than one 40 minute session, once a week. Myndlift is the first home neurofeedback program we have identified that gives patients access to neurofeedback on a daily basis, while allowing a board certified clinician to have full control in deploying and monitoring the neurofeedback protocol.
Myndlift provides a powerful solution to some of the major barriers we see in neurofeedback. The Myndlift system is the first viable option we’ve identified that allows the board certified clinician to deploy and monitor a home neurofeedback program. This allows patients to train in an affordable and convenient way that overall increases treatment compliance and consistency.
Brieanna Scolaro, LMSW – In addition to the clinical benefits, Myndlift helps advance the field of neurofeedback in general. A majority of the general public remains unaware of neurofeedback and its benefits. Myndlift is helping to educate society and shape the picture of what neurofeedback actually is. Myndlift also helps combat the barriers within the mental health field at large. Remote training can help make neurofeedback accessible in rural areas and suburbs where other services may not be available. On average, Myndlift can be packaged in a way that is more affordable and effective for a patient. Typically, we allow our Myndlift trainers to complete 30-60 training sessions per month for a price that is comparable to 1-2 office sessions with a licensed psychologist.
5) How has Myndlift impacted the way you administer neurofeedback?
Dr. Robert Reiner – Traditionally, we have provided neurofeedback and qEEG brain mapping here in our office. After incorporating Myndlift, we combine both in-office and at-home technologies, which perfectly complement each other. After the board certified clinician administers the qEEG brain scan and sets up the neurofeedback protocol, our patients can continue their training in the comfort of their own home. This positions neurofeedback training more like daily homework that is closely monitored by a clinician, rather than requiring the patient to physically visit the office for their training. As a result, Myndlift has allowed us to increase the overall number of neurofeedback patients here in our office, while still providing personalized care and close monitoring to each patient. It also has the added benefit of freeing up office space for patients who need other types of on-site therapy we provide, such as Cognitive Behavioral Therapy (CBT) and Virtual Reality Therapy.
Myndlift also enables patients to train using a very convenient and simple setup, eliminating the need for large caps which leave clients with a head full of gel. Depending on the required protocol, Myndlift can be used either with the Muse headband alone or with a single electrode (placed anywhere on the head), requiring little or no conductive paste. Many patients dislike applying a lot of gel, and therefore find that the Myndlift setup suits their lifestyle and doesn’t deter them from doing their trainings.
6) How have your clients responded to using the Myndlift system?
Brieanna Scolaro, LMSW – Overall, our patients love using Myndlift, either as a standalone intervention or as a complementary treatment to other forms of therapy. We've seen that training has led to real impact, both objective and subjective. One patient, who has been working directly with Dr. Reiner, shares about his Myndlift experience:
“I am becoming more calm and, more importantly, am more aware when I am less calm. I have improved ability to slow myself down in conversations so that I am more able to hear the conversation and respond directly to the ideas being discussed without interrupting or disrupting the progression of the conversation. I am becoming more able to notice when my dyslexic-frustration is beginning (when I feel trapped by a situation) and beginning to be able to step back from it and consider how to respond or not to respond. I am also sleeping better. I have been working on these interpersonal problems all my adult life, but I feel that the Myndlift exercises are showing accelerated improvements.”
Another patient of Dr. Reiner’s, like many others, has objectively realized just how far they’ve come during their follow up qEEG brain scan: Before starting Myndlift training in late 2017, the patient reported anger issues and extreme emotional sensitivity. For the next few months, she completed 60 minute sessions of Myndlift on a daily basis.
The two brain maps shown below (before – left, and after – right) show how daily training has cleared up most of her brain dysregulation [provided with the consent of the patient].
The personalized YouTube video training option offered by Myndlift has been a huge factor in increasing patient motivation.
As the Myndlift Program Coordinator, I use an individualized approach when helping each patient figure out how to best incorporate Myndlift into their daily routine. For the past three months I have been working with a teenage boy and his family. Like many other teenage boys, seeking therapy or doing some type of training wasn’t high on his list of cool or interesting activities. By working with the family, we were able to hand-pick videos that would be more appealing for his training. After adding 15+ YouTube videos, the young man actually asked his psychologist to increase the amount of training time each day.
Another one of my patients, age 70, prefers to only use video training when completing her 30 minutes of training a day. We work together to curate interesting content and Youtube links, which increases engagement by adding another opportunity for a patient to be involved in his / her treatment.
Immediate feedback and powerful analytics increase treatment compliance.
Another patient was using Myndlift in addition to CBT and mindfulness practice to combat panic attacks. One morning, she emailed me stating, “This program is a simpler version of neurofeedback that I can use daily from home. It is entertaining plus I like that I get to see my achievements, which encourages me to keep going.” Offering patients immediate feedback on their training, along with other data that makes sense, is a powerful tool in maintaining and increasing patient motivation, and overall treatment compliance.
7) How would you sum up your Myndlift experience so far?
Dr. Robert Reiner - Myndlift provides a powerful solution to some of the major barriers we see in neurofeedback, as it allows certified clinicians to deploy and monitor a home neurofeedback program. This allows patients to train in an affordable and convenient way that overall increases treatment compliance and consistency, resulting in great outcomes.