TRANSCRIPT:

Hi there. I'm Fernando. Bernall welcome to the physiology matters podcast.

Today's episode revolves around the topic of cranial electrotherapy stimulation. The use of electricity as a form of therapy is not new, is as old as the electric eel which was used about 2000 years ago by the ancient Egyptians, the Romans, the Greek for the treatment of pain, fast forward to our current times with modern technology and a better understanding of the brain, has led to creations of devices that can deliver current into various regions of the brain in an effort to treat various conditions of neuro electrochemical origin. One such device is the Alpha-Stim.

I'm joined by Dr. Josh Briley Briley? Briley, yes.

PhD, who is the clinical education director for Electro Medical Products International, Inc. The manufacturer and distributor of the Alpha-Stim devices. Dr. Briley is a licensed clinical psychologist, after earning his doctorate in clinical psychology in 2003 from the university of North Texas he begins his career at the Federal Bureau of Prisons, Where he focused on drug treatment, crisis intervention and anger management.

He was quickly appointed leader of the crisis support team for each institution he worked in as well as appointments as regional assistant team leader, Dr. Briley then transferred to the health veterans health administration working in a small community outpatient clinic in Central Texas, where he specialized in individual and group therapy for PTSD, depression, anxiety and chronic pain treatment.

Dr. Briley has also owned a private practice, taught online undergraduate and graduate level courses and conducted teletherapy for BetterHelp.com. He currently serves on the Daily Life And Workplace Stress Board for the American Institute of Stress.

Fernando Bernall: "Dr. Briley. Thank you. And welcome."

Dr. Briley: Thank you. It's a joy to be here.

Fernando Bernall: Good, could you give us an idea, what is the difference between a clinical psychologist and a general psychologist?

Dr. Briley: Uh, Really I so, like the difference to me would be more like somebody who has a doctorate in counseling psychology versus clinical psychology.

So clinical psychology focuses more on, um, the more serious mental health issues, uh, schizophrenia bipolar. You know, the more the personality disorders, not that counseling psychology doesn't, I'm not trying to diminish any of my colleagues out there that are in the trenches, doing hard work, trying to help people live their best lives.

Um, the counseling psychology, uh, at least in my experience in, you know, talking to my colleagues and my co-students at North Texas, um, their courses were more in like family therapy. Um, kind of general, um, you know, every day stress related things, as well as, you know, the ma the mental illnesses, as far as depression, anxiety, PTSD, substance use all of that.

So it's just very slightly different training backgrounds is all

Fernando Bernall: I See. So, so it, it, would you say then that a clinical psychologist is, uh, Step before a patient may have to use some type of pharmaceuticals and go to a psychiatrist or something like that?

Dr. Briley: Um, actually it's generally the other way around, at least in this country.

Um, and in most Western Western societies, generally we get referrals and it's clinical or counseling, psychologists, LCS, Ws, L MFTs, you know, any, anybody out there doing therapy. Uh, we tend to get referrals from either psychiatrists or from general physicians who have already prescribed medications. Um, and then

you know, they know that therapy can help with that. Uh, or the patient doesn't want to take medications. And so they they're referred for therapy. Hmm.

Fernando Bernall: And as a clinic of psychologist, uh, how do you integrate Alpha-Stim into your practice? In, in the clinical setting?

Dr. Briley: Okay. Um, So I actually began using Alpha-Stim while I was at the VA.

Uh, so about 2018, I believe is when I finally was able to kind of get my hands on one, start using it with my patients. Uh, and I just incorporated it into the normal, um, Services I was already offering, uh, so I had nine therapy groups a week. I had, um, you know, individual sessions throughout the day crisis intervention sessions.

And, um, so I would offer them all on Alpha-Stim to use during session. Um, they could put the ear clips on, we'd set it, you know, make sure we had it set correctly for them. And then, you know, Go on with group or individual as normal. And with my VA, I had to do two trials before I could order a device for a veteran.

So we would just do it during our normal course of, you know, during our normal sessions. And then I would document, you know, their. Uh, pain rating, their emotional distress rating before and after demonstrate, you know, document that I had trained them, how, and then they had shown me how to use it. So they had proficiency with it and it worked well enough.

Like word of mouth got out among veterans. And it went from, you know, um, especially here in Texas, mental health is always kind of a last resort. Like I'll, I'll go see you when, when you know, I've, you know, as, as like the last thing before I just completely lose it. right. Texas very much has. And, and for better or worse, Texas very much has to pull yourself up by your own bootstraps mentality.

And especially when you're dealing with an alpha male type population that veterans tend to be talking about people, sharing your emotions. You know, admitting that you're having problem is, is hard and feels like a weakness. So. You know, it, it's kind of our last resort thing. Um, and so I went from, you know, oh, you're the psychologist.

I don't, I don't wanna talk to you. Or I'm only here because my doctor is requiring me to come see you once a year to, um, and that definitely wasn't my experience with everybody. I mean, I had, well over 150 people on my caseload, uh, at any one time with between groups and individuals. So, you know, it's not like I was sitting there doing nothing.

Um, but all of a sudden I became the most popular. Provider in the clinic because word of mouth was getting out about this Alpha-Stim device and you know, how much better my patients were sleeping, how less keyed up they were all the time. Um, the veteran's spouses were talking to each other and, oh, you've gotta send your veteran in to go see Dr.

Briley, cuz he's got this magic box that makes everything better. And so all of a sudden I became very, very popular. You know, and some people only came in, got the Alpha-Stim and then I would only see them, like when they came in for something else in the clinic. But a lot of people, I was able to get plugged in to my normal services as well.

So it, it, it actually incorporated very, very easily into what I was already doing. Um, and then I found, you know, many of my veterans were able to at least come down off their psych meds. A few of them kind of came off of 'em completely. Came down off needing narcotics to maybe just, you know, less addictive pain meds or even no pain meds.

Uh, so it really was a game changer. I was telling everybody about it. I told all my colleagues in the clinic, you know, all the physicians and nurses got them all hooked up on it so they could see what it was like. Um, started telling. Uh, other, you know, other psychologists and other clinics in the, in the central Texas VA system and kind of helped them get established and showed them kind of my templates and how was using Alpha-Stim. So I got them to be able to offer it to their veterans. Um, and it just flowed very, very easily into how psychology was already doing things within the VA. Hmm. So,

Fernando Bernall: So did they take the unit home or was only used when they were in session with you?

Dr. Briley: So this, one of the things I love about Alpha-Stim is it's designed to be used by the patient at home.

Um, so I would do the two trials in the clinic, which is the least I recommend for any provider to do, um, that way you show 'em how to use it. And then they. Show you, they know how to use it. And then plus you get a chance to see, you know, how well they're gonna respond. Um, and so that way, you know, that's, you, you aren't giving them something.

That's just gonna sit on the shelf. Um, you know, you, you are pretty sure that they're engaged, they're gonna use it. And then, um, prosthetics would order one, um, and ship it to the veteran. And a lot of them would, you know, they used it every day, every other day at home or, and, and a lot of 'em would bring it into session with them.

And so they would put it on during their group sessions. They'd put it on during their individual sessions. And what we found was when they did that, when they wore an Alpha-Stim during session, We were able to get into the meat of their problems a lot quicker and easier. Um, cuz you know, when, when you're coming in to, to talk to a therapist, you're not coming in to talk about the good things that happened to you in your life.

You're coming in to talk about the painful things that are very emotionally driven, very emotionally Laden. And as you talk about them, the emotions. come up! We, that happens with any strong memory. Um, so an example I would I give patients is, you know, if you really kind of bring up the memory of your firstborn child and start to talk about and start tell people about it, those emotions you felt that day also come up, the excitement, the nervousness, the happiness, assuming it was a good experience.

Um, all of that comes up. But because it feels good. We don't stop it. So we don't think about it. But if you're talking about a painful memory, those emotions come up, but they're painful. So we push them back down and we try not to think about it. Try not to talk about it. So when you're in therapy, those are the very things we need to talk about.

And when those emotions come up, um, one of my veterans described it as holding a beach ball underwater. You can do it for so long, but the longer you do it, when you finally lose control of that beach ball, it's gonna come. You know, if you just push it down, let it up. It's just gonna kind of bounce back to the surface.

If you hold it under for a long time, when it finally breaks free of your grasp it's gonna come up and heat you in the face. Um, and I thought that's an excellent analogy. Kind of when most people come into therapy, the fourth or fifth time they've been hit in the face. So, um, you know, and they still, you know, and they bring that method of trying to deal with the pain in the therapy with them.

So they know they need to talk about it, but it hurts and they don't wanna talk about it. And then when they do talk about it, all the emotions come up and especially with the population I was working with, um, you know, there's a lot of anger behind what happened to them. Um, , you know, either they felt like something didn't go right.

Or, you know, their buddy that got injured or killed shouldn't have, and they they're blaming somebody or they're blaming themselves. Um, there'd be a lot of, uh, sadness and depression that came up and it would get overwhelming and flooding. And there were several times where, you know, we, I would keep them in that moment for a little bit.

And then I'd be like, you know, I mean, they're, they're get they're, they're getting to where they can't handle. What they're feeling. Um, and I, you know, I didn't wanna have them walk out more emotionally unstable than they came in. So it stop the session we would deescalate. We would calm down, you know, kind of shoot the breeze a little bit.

And then that would be the end of the session with Alpha-Stim that didn't happen. So they would still feel the emotions. They would talk about what they went through, no matter how painful it was, tears would flow. Um, you know, you could see like, you know, their teeth would grit. If they were angry, they'd clench their fist.

You know, they felt it, but they were able to talk about it, talk through it. And then when, then the story was over. They kind of naturally deescalated and went back to calm on their own. And I saw, I, I heard parts of their experiences that I had never heard even after almost a decade, working with some of these men.

And, um, they progressed. So much more quickly. Um, and there were a few that I actually saw once we, you know, kind of worked through, okay, there's this is what we call the index trauma. So the index painful event. And then once they got that dealt with another one would pop up and be like, okay, my turn. And the, the theory in working with somebody like that is that each success of one is supposed to be easier for them to cope with.

And, and process and deal with. That's not actually my experience. Um, the emotions are painful. Regardless. And so with Alpha-Stim, they were able to do that much more quickly, much more easily. Um, and it just made their life better. It made my job easier, uh, made our time together, way more productive. Um, so I, you know that, and that's one of the reasons why I was reaching out to everybody.

I knew. Going, you've gotta try this with your veterans. Trust me, you know, it's right. This, this is amazing.

I, you answered a question that I had already, and that was, if, if you're in therapy and you are talking about things that are painful, uh, trauma, that you might have suffer either at the war or home or , whatever situation you were in, that really made a, an impact in, in your, in your emotions.

And you're talking about these things, I would think that there would be a conflict in the brain with the chemistry that the emotions, uh, bring about while Alpha-Stim is trying to regulate that. And, and I it's fascinating, but I'm not quite sure I understand, uh, the whole process. All

Dr. Josh Briley:

right. So speaking, neurological.

Um, you know, the, the nervous system is electrochemical. And in Western medicine, we focus on the chemistry. We focus on the neurotransmitters. We focus on the brain chemicals, all of that. And that's important. I'm not saying it's not, but the chemistry is controlled by the electrical. Components. So, you know, the way a nerve cell works electrical current travels along the body, the nerve cell reaches the axon, terminals, the receptors, open up the neurotransmitter, flood into the synapse.

They, you know, activate the receptors on the other nerve cell, build up a charge, and then that charge fires down the next cell. Um, The types and the amount of neurotransmitters that go into a synapse are at least somewhat dependent on the intensity of that electrical charge. And, um, FMRI studies have seen, have shown, uh, different imbalances in the electrical functioning of the brain that we.

Tied to different emotional states. Uh, so for example, with depression, um, symptoms of depression are ruminating turning inward. Um, You know, kinda lack of activity, lack of social things that seem, uh, as, you know, fun or as enjoyable as they, you know, that you used to enjoy, they're not as much anymore. Um, and what they found with depression, FMRI studies is that the parts of the brain that are involved in that ruminating and looking inward and, um, you know, it's just kind of feeling down and sad are very hyperactive.

while the parts of the brain that are active when we're very social and outgoing and engaged in, in doing things that we enjoy doing. Is very underactive. And it's the same thing when you're, you know, talking about an experience. So if you're talking about an experience that makes you anxious or scared, the, that part of the limbic system, those parts of the brain get activated in that electrical and your brain starts firing, you know, those, those electrical signals.

If they're firing too many electrical signals, that those areas are overactive, then you're going to feel that emotion even more intensely. Whereas with Alpha-Stim, all we're doing is balancing the brain. So we're sending a wide range of, of biological frequencies to activate the nerve cell receptors and either stimulate or inhibit the nerve cell activity, depending on what needs to be done.

And the nerve is the one. decides that. So if a nerve is hype is hyperactive, it's not going to respond to frequencies that would make it more active. It's going to respond to frequencies that calm it down and vice versa. So in therapy, um, as the cells starts to get, you know, those cells start to get really active and those parts of the brain get to be, you know, kind of hyperactive.

If they have the Alpha-Stim on at that time, it helps to bring that back down. And they're able to still feel the emotion. It doesn't completely flatline it. Um, it doesn't make them an emotional zombie. They're still able to feel it, but they feel it at the appropriate level. Um, and instead of being flooded and overwhelmed by it and kind of, you know, having their sympathetic nervous system activated to the point where they just can't function anymore.

Um, or they just want to, you know, run from the room or. You know, defend themselves. So alpha stem helps to balance all that out and lets them get through it.

Fernando Bernall:

Would you say then that, uh, would it be fair to say that Alpha-Stim uh, works similar to an adaptogen?

Like L-Theanine for example, L-Theanine in green tea, uh, is known to, uh, uh, bring down cortisol and perhaps, uh, okay. Supposedly it increases. Uh, alpha brain activity, uh, when taken regularly, would you say it's a similar,

Dr. Josh Briley:

so that, so that, so that would be a good comparison. I believe. Uh, we do have, uh, EEG studies that show, um, Alpha-Stim can increase activity in the alpha wave, uh, frequencies kind of induce that alpha state that relax, calm kind of tranquil feeling.

Um, but also tends to decrease Delta wave activity, especially in the frontal lobe right here behind the eyes, so that you feel very alert and focused. Uh, but there again, we've also have studies that show of people started with high levels of alpha activity. By the end of the treatment that alpha activity has actually decreased.

So it's not forcing a specific response. It's not forcing a spec. You know, it's not, it's not inflating alpha activity regardless of where the alpha activity starts. If that makes sense. It's literally just bringing it into that zone where you're in the alpha state

Fernando Bernall:

is the, the patient more suggestible at that point?

Like a form of, would you say, uh, electrical hypnosis?

Dr. Josh Briley:

Um, no, no, I wouldn't say that. Um, they, their defenses were down, so they were more able to participate in the therapy, um, process. Uh, so for example, in one of my PTSD groups, I, um, had a veteran, uh, who, great guy loved him to death, but he was the class clown.

So if things got really heavy, really intense, I could almost set a watch by the fact that he was about to say something humorous and inappropriate to kind of break the tension. And that was his way of coping with things. When he got uncomfortable, right. Worked with this man with this group actually for years.

Um, and then one day he came into group. He was about mid to late forties, I would say. Um, and he'd had like five back surgeries by then. He came into group one day and it was a bad pain day for him. He was just moving very slowly, walking hunched over barely move, you know, kinda shuffling his feet. And one of his fellow group members had brought in an Alpha-Stim that the VA had just sent him through neurology and he didn't remember having gotten it.

He didn't remember talking to anybody about it. He just walked in and he was like, what is this? And I was like, oh, it's the Alpha-Stim. You know, I'm I didn't have one in my office at the time yet. So I was kind of all excited to see one. And he was like, I don't know what it is. I don't know how to use it.

And neurology had helped another veteran get one. And so he knew how to use it. So he was like, oh man, I'll, I'll show you how to use it. This thing's amazing. And the guy who brought it in didn't want to, but this guy with, you know, the, the class clown and the, and the bad pain that day was like, Hey man, I'll, I'll, I'll try anything.

So we put it on. And I noticed about five minutes into it. He just kind of sank in his chair and was just very calm. And then I noticed that he was engaged in, in therapy. He was making, uh, comments. He was helping, you know, re respond and helping people, but it was all 100% on point. Not at all, distracting, not at all the, his normal.

Behaviors. And I'm like, okay. That's, that's interesting. I didn't have a lot of experience with alpha stone at the time. Uh, so then we finished the treatment. Uh, he only needed a 20 minute treatment and, you know, took the clips off the guy who brought it in was like, okay, yeah, I'll try it. So we put it on him.

Um, at the end of the group, about 30 minutes after his treatment had ended, this man stands up, looks really confused and sits. And I'm going, dude, what's up. And the whole group stopped, cuz this was a very close knit group. They all like, you know, loved each other, supported each other. It was an amazing to watch all of these veterans come together and support each other.

That it's one of the reasons that did so many groups. I love seeing that dynamic. So they of course all I'll stop to see what their, you know, and what in their minds their brother needed. And he stood up and he kind of stretched. Stood up really straight. And he was like, guys, my back doesn't hurt. And I was like, really?

And he goes, yeah. And I'm like, well, I also, I said, how are you feeling emotionally? Because you weren't a cut up in group today. And he's like, yeah, I feel really calm and relaxed. And I'm like, okay, great! You know, and so then of course everybody wanted one cuz right. Um, so I, I have seen that where like their defense mechanisms won't be as high.

Um, you know, and so they're more engaged in the process, but I wouldn't say more suggestible.

Fernando Bernall:

I see.

So years ago I was working in, in Wilmington, Delaware where I worked in a outpatient, clinic for, uh, substance abuse. Mm-hmm and I was doing auricular acupuncture at that time. And there were some patients that began to, uh, say that they were having hallucinations after the treatments.

uh, I don't know why, but they were saying that. So we had to kind of monitor who would be more susceptible to maybe, uh, even if it was in their mind fantasizing that, uh, we had to watch out who we did this treatments to

Dr. Josh Briley:

right.

Fernando Bernall:

Who would not be a good candidate for alpha stem, other than someone that may have a pacemaker or something like that.

Dr. Josh Briley:

That's really about it.

Um, so somebody with a pacemaker defibrillator, um, maybe a cochlear implant, um, that's the only contraindication, uh, for an Alpha-Stim. Other than that, it's a very general treatment. It's a very safe treatment. Um, our side effect ratio is 0.11% of the time, uh, over the last 10 years. And I know that cuz I'm the one who runs those numbers.

Uh, so um, as of last year, at the end of last year, um, you know, we'll see what the ratio is this year. But when you look at, you know, number of units that we sell versus number of. Adverse effects reported to us. It's an extremely low number it at 0.11%. We've never had a, a significant or serious adverse reaction ever reported.

Um, we've never had to report anything to the FDA. Um, which, you know, you report to the FDA when there's a serious injury or they have to like go to the hospital because of your treatment or, or something like that. We've never had anything like that. Um, what we do tend to find is people may have a little bit of dizziness or headache, um, after treatment generally that's because they current, they had the current turned up just a little too high.

Um, if they'll put the air probes back on, turn the current down let it run for a few minutes, then that headache or dizziness will go away couple minutes after that they can turn the device off. So other than that, we're effective for about 85, 90% of people who try it. Um, You know, uh, uh, one survey we did recently showed about, and again, depending on what indication we were treating the anxiety, depression insomnia or pain, but the range was between, uh, like 85 and 94% had at least a 25% improvement in their symptoms.

Fernando Bernall:

So let's talk a little bit about the recent, uh, article and the umbrella, uh, review that was done regarding, uh, Serotonin and depression,

Dr. Josh Briley:

one of, one of my favorite topics at the moment.

Fernando Bernall:

Yes . And, and, you know, I, the articles in the review seems to suggest that, uh, physicians have been, uh, suggesting that serotonin is the root of the deficiency or lack of serotonin, the root of depression. I, you know, I used to have this huge book, uh, the physician's. Reference book mm-hmm and I remember looking through it for, so I like pharmacology.

I like cuz I learned so much about physiology, uh, by reading the mode of action of, of medications.

Dr. Josh Briley:

Right.

Fernando Bernall:

And uh, so that's why I'm always asking what's the mode of action. What, how does that work? I'm into the physiology of things.

Dr. Josh Briley:

Good.

Fernando Bernall:

But a lot of the times when, when I looked at these medications, most of the time you always had the language that said it has thought that,

it is believed that, evidence seems to suggest that, I don't really recall an straight answer saying depression is caused by serotonin deficiency. Have you come across any, any literature that actually adamantly says that serotonin deficiency?

Dr. Josh Briley:

No, I haven't. Uh, and actually I took a continuing education course several years ago. Uh, that was. the instructor was a pharmacist. Who's also a licensed professional counselor, um, which I thought was funny. He can fill your prescription and he can recommend that you go talk to your doctor to get a prescription, but he couldn't write the prescription. so right. Um, but so, but, but he was uniquely qualified for this course.

He was teaching cuz he underst. Depression and anxiety and all the mental health disorders and, and was a therapist and, and you know how to treat them, but he was also a pharmacist. So he fully understood exactly what you said, the mechanism of action for medications and how they work on the body and how they interact with, you know, different things that you're doing or taking and, and all that.

So it was very, very interesting course. Um, but he said repeatedly, especially talking about anti antidepressants, we are. Um, 100% in the realm of theory here, we don't know. And he mentioned like, I think there's seven different types of serotonin receptors that identified then this was more than 15 years ago.

So I'm assuming, uh, There's probably more, I think

Fernando Bernall:

last time I read were 15 that they've identified. Yeah.

Dr. Josh Briley:

So yeah, time they're talking about like seven,

Um, but they only knew what about five of them did. Uh, and three of 'em were related to digestion. So, you know, he's like, we, we really don't know. We think this is what happens.

You know, we, we think that they are increasing serotonin levels, you know, and, and he said one of the, one of. Kind of issues with especially SSRIs and medications like that is, you know, we, we can, and, and this is the way SSRIs are believed to work is increase the amount of serotonin in those synapses. But we can't tell the body where to put this increase of serotonin.

So it's not like we can say, okay, you're going to take the serotonin and bond it, only to the mood receptors, you know, so that's why a lot. And, and, and he kind of mentioned this and right before he mentioned it, I was like, oh, I wonder if, and then he confirmed it. That's why a lot of SSRI have a lot of digestive side effects.

Because serotonin's involved with digestion and it's why depression and anxiety have a lot of digestive and gastrointestinal symptoms, because serotonin is so involved in that

Fernando Bernall:

in fact, that the, the gut has a lot more serotonin than anywhere else in the body. I mean much more than

Dr. Josh Briley:

exactly. Yeah. One estimate I saw said about 85% of the serotonin in your body is actually in your gut.

Fernando Bernall:

Right.

Dr. Josh Briley:

So, um, So, you know, it's even the, you know, so, and as you mentioned, you know, if, if you take a pain med, they can tell you how it works. If you take an antibiotic, they can tell you what it's doing. Um, and that's one thing he described is why we're in the realm of theory. When you're talking about mental health disorders is, you know, if they're trying to develop an antibiotic.

They can put a whole bunch of bacteria in a Petri dish, put that chemical in the Petri dish and see how much of it kill, you know, how much of the bacteria is killed by it.

Fernando Bernall:

Right.

Dr. Josh Briley:

They can't put depression in a Petri dish, put an SSRI in there and see what happens. So, right. You know, um, so like I said, it was a very interesting study, but all the research I've read.

Um, and, and anytime you talk to like a pharmacist or, or, you know, somebody who's really into pharmacology, they'll admit, we think this is what's happening. It's it's you know, I had actually, and I had seen some research before this umbrella review that question that. you know, is, is this really what's happening?

Are we really going down the right path? Are we really telling patients the right information? Um, and then this umbrella review, which looked at of course, existing literature going back, I believe a decade, including, excuse me, including a genetic study that had, you know, well over a hundred thousand participants and their conclusion was.

There doesn't appear to be an association between serotonin levels and depression,

Fernando Bernall:

or perhaps that there is no association of serotonin be the only, uh, reason for depression.

Right?

Because I, you know, when, when I looked at, at some of the, the studies, uh, or the research on the Alpha-Stim' website, uh, and, and it was in indicating that, uh, cerebral spinal fluid show, higher levels of serotonin

Dr. Josh Briley:

uh, after

following a following a CES treatment.

Fernando Bernall:

Yes. Right. So unless, I mean, serotonin doesn't last that long. Uh, and I think maybe perhaps looking for the metabolites of serotonin might have given a better indication, but the fact is that, according to what I read there, mm-hmm they were higher. Uh, I, I, including.

Or other, other neurotransmitters, a beta endorphins and so on.

Dr. Josh Briley:

Right.

Fernando Bernall:

So we can't really say that serotonin does not play a role. It's just not the only role.

Dr. Josh Briley:

Right. Exactly. And I don't think the human body is so easily categorized as to say one thing causes anything. Right. Um, you know, um, so even, I mean, conditions, you know, Heart disease, you know, there, there for a long time and was, oh, well, diet diet is the cause of heart disease.

Well, okay, great. But what about that marathoner that eats healthy and had a heart attack, you know, it's so there's a lot of factors that play into any. Anything involving the human body. And so I, I, and I always thought it was an oversimplification to just say, oh, well, it's just serotonin or well, oh, it's serotonin and nor- epinephrine.

Um, trying to say it's only a chemical disorder, I think takes some of the opportunity. For helping people out of it, because if it's only a chemical disorder, then your only treatment option is medication and medications work sometimes, sometimes they don't. Sometimes it takes a long time to find the right combination.

Um, I think looking at the electrical activity of the brain with these disorders and the electrical activity is influenced by a lot of environmental factors, personal factors, um, genetic factors, um, as you know, as well as we are able to influence the electrical activity in our brains. Um, so, you know, if I tell you if I, you know, if you've got an F you know, if we're looking at say FMR differences, and I tell you a sad story, really, really sad story, the electrical activity in your brain's gonna change based on that.

You know, maybe not a lot, but it'll change. And as I mentioned earlier, the electrical properties of their brain controlled the chemical properties. so, and vice versa. It's, it's not strictly a one way relationship.

Fernando Bernall:

Exactly.

Dr. Josh Briley:

You know, it's symbiotic, everything in the body is symbiotic. So, but by with CES, our primary mode of action is that electrical activity in the nervous system.

And then by balancing that and affecting that downstream, it'll have an effect on neurotransmitters, but the primary focus, the primary motivation is that electrical.

Fernando Bernall:

Right. Right. So eventually then downstream, there will be some chemical involvement in it.

Dr. Josh Briley:

Yes.

Fernando Bernall:

Right, right. So, um, you mentioned earlier about the, the veteran that, uh, you stopped the treatment after about 20 minutes.

What determines the dosage? How long should you. keep

Dr. Josh Briley:

okay. Yeah.

Fernando Bernall:

the unit on a patient.

Dr. Josh Briley:

Um, and that's like I mentioned earlier, so the correct dose for alpha stem is an inverse relationship between the current that they can tolerate and the amount of time they need to treat. So if there's someone like me, they can't tolerate, you know, very, very high levels of current and high being relative here, cuz at its highest Alpha-Stim is about half a mil amp and electricity. So it's still minute for most people. It is a completely subsensory treatment. Um, most people, if you feel anything on the ear, on your ear clips or at where the electrodes are, what you're feeling is the spike in our wave form that's designed to disrupt the electrical activity. Uh, or the skin electric, the skin resistance, electrical resistance in your skin.

Ah,

um, and so that lets our wave form kinda get into the nervous system very easily.

Fernando Bernall:

Oh it does glad you said that.

Dr. Josh Briley:

Yeah. Yeah. So that's, that's what you're feeling. You're not feeling the current, you're not feeling the wave form. You're filling those spikes.

Fernando Bernall:

Do you desire to feel the spike? Do you?

Dr. Josh Briley:

A lot of people don't feel it and that's perfectly ok..

Fernando Bernall:

I see

Dr. Josh Briley:

um, it's, I, I don't really feel the spikes when I put the air clips on what I feel is the dizziness. Uh, but I also get motion sickness very, very easily. Mm-hmm so I think that's what is, I think, anything that starts to mess with my, or, you know, influence my inner ear. gives me vertigo. So, um, and I don't know for a fact that's what it is.

I'm kind of doing an informal survey when someone calls in and says, Hey, you know, I, I put this on at, at a level one and I got dizzy. One of my questions is, do you give motion sickness easily? And a lot of people say yes, but some say no. So even that's not a hundred percent what the reason is.

Fernando Bernall:

Right, right.

Dr. Josh Briley:

Um, just everybody's nervous system is different

Fernando Bernall:

right.

Dr. Josh Briley:

And so if they can, if they can go to 250 to 400 microamps without feeling that dizziness or that discomfort, then they only need 20 minutes of treatment. If they're between 100 and 200 microamps, then they'll need a full 60 minutes, uh, of treatment.

Fernando Bernall:

Got it. Got it. So, um, when you have the probes in the ear, is there, uh, a region of the ear where it's more effective, maybe there's less collagen, less, uh, fat or, or more of it.

Dr. Josh Briley:

Um, so you can move it around different parts of the ear. To see where it works best. Mm-hmm the, the, our recommended placement is on your earlobe as close to your jawline as possible.

Um, because there is a nerve cluster there. And so you put it there and it's gonna travel. You know, it's gonna hit more of that nerve cluster and go into your. Inner ear.

Fernando Bernall:

You mentioned the eighth cranial nerve uh, innervating the earlobe. Mm-hmm uh, I have read where at times that they were putting them in, I'm assuming by way of pads, I don't know, on the eyelids.

Dr. Josh Briley:

Um, yeah, so that was what, the 1950s or sixties when they were trying to kind of figure out best placement. Um, and so they would do that. They would, um, somehow another. Uh, electrodes on the eye, uh, eyelids and on the back of the brain to get that current going through this way instead of ear to ear, um, and you know, left to right is the more preferred method now.

Um, For any CES device, um, you know, there's some that use sponges on the temples or some that use, you know, the big headphones we use ear clips, um, they're generally pretty comfortable and an obtrusive. And, um, so yeah, but they used to do that. And then what they found was, um, like vision blurring and, and those, you know, the flashing lights

Fernando Bernall:

right.

Dr. Josh Briley:

Um, just from the optic nerve being, it wasn't doing any damage. It was just that optic nerve being stimulated. Um, we still have people now, even with putting it on the ear clips, if the current, you know, they may not feel dizzy, but they may see flashing lights from the current hitting their optic nerve.

Um, and it's not at all harmful. We just say, go ahead and turn it down. Um, until that goes away so

Fernando Bernall:

far out.

I have really enjoyed this. I have learned a great deal.

Dr. Josh Briley:

Well, thank you. I have too.

Fernando Bernall:

And, uh, , I want to thank you for taking your time and coming to, to do this. I, I look forward to, uh, continuing to use the unit in my practice.

It has helped a lot of my patients. Um, there's a lot to learn.

Dr. Josh Briley:

All right. And, uh, um, I'm glad to hear it. And, you know, E P I offers free customer support, clinical support and technical support for the life of the device. Um, so if they have any issues with, uh, with their device or, or trying to figure out how to use it best for them, call our toll free number Monday through Friday eight to five, um, central time.

And we'll be more than happy to help you out.

Fernando Bernall:

Thank you very much. I appreciate you coming.

Dr. Josh Briley:

All right thank you.

Fernando Bernall:

We'll talk soon. Thank you, sir. Yes, bye.

Dr. Josh Briley:

Bye. Bye.