Bruce Bassi#FuturePsychiatryPodcast discusses novel technology and new ideas in the field of mental health. New episodes are released every Monday on YouTube, Apple Podcasts, etc.
Summary
Dr. Scott Burwell, PhD spoke about the company he founded, Neurotype. Neurotype is building brain sensing tools that help patients recognize situations in which they feel triggered to help determine the effectiveness of treatment on brain reactivity and cravings. This would allow you to incorporate elements of CBT and mindfulness based on information gathered from the device. It would also help a clinician and patient to track the effectiveness of therapy over time. The goal is to help the patient better identify triggers, and then learn how to become less triggered by them.
How does it work? Who should use it? What is the expected setup, and how would a clinician use it to augment decision making? What features are expected to be added on in the future? What is brain “reactivity” and does treatment for reducing reactivity lead to a reduction to other non-addictive stimuli?
Chapters / Key Moments
00:00 Preview
00:22 Introduction to Podcast
01:28 Dr. Burwell’s Background
03:59 How is EEG Being Applied in Psychiatry?
06:09 What is Brain Reactivity, and How is it Seen on EEG?
08:52 How Can Stimuli Be Triggered Subconsciously/Preconsciously?
10:32 How Does It Work?
15:32 Working on Digital Therapeutic “Brain Games”
16:54 Goal to Improve Patient-Clinician Interaction
19:12 Balancing Science w/ Creativity
21:57 FDA Challenges
25:10 Current Efforts on Trials
26:44 Are There Any Misperceptions? Is it like neurofeedback?
31:51 What Was Your Biggest Surprise?
34:03 Why Target SUD Disorders and not Anxiety
36:44 What Do We Need To Do In 5 Years?
Transcript
Introduction
Scott Burwell, PhD: You can hear about in the newspaper, you can read about in a journal article, but when you’re actually talking to somebody about their unique journey, it’s incredibly eye opening. There are just so few options out there for treatment, and if we can be one option for one type of person or at a certain person’s step of their journey to recovery, that is our dream.
Bruce Bassi, MD: Hello and welcome to the Future Psychiatry Podcast. I am your host, Dr. Bassi. I’m a physician and biomedical engineer passionate about tech and mental health. I created this podcast to try to bridge the divide between the tech world and the many clinicians out there who are interested in tech. We talk about novel ideas, technical challenges, and future directions. Additional resources and a full transcript can be found on our website telepsychhealth.com. Then click podcast in the top right corner of the screen. New episodes are released every Monday. As we are just starting off, I would greatly appreciate if you subscribe to the show, or even better, what would help us the most is if you share it with your friend group on social media. You never know if there’s someone out there who would benefit from this information or have a new idea that sprouts the next innovation in mental health. I hope you enjoy listening to the show. Thanks a lot. Today we’re speaking with Dr. Scott Burwell, who is the founder of Neurotype. Neurotype is a portable brain sensing tool that uses EEG to support people in recovery and those who struggle with substance use disorders. So before we start talking about Neurotype, let’s just hear a little bit about your background and how you got interested in this.
Dr. Burwell’s Background
Burwell: Yeah, thank you so much, Dr. Bassi, for having me. So I got interested in substance use disorders, I think going back to my family owned a liquor store when I was growing up, and so I worked there for many years and have a lot of experience working from behind the counter. One thing that always kind of interested me about substance use disorders is how some people can have all the risk of vulnerabilities, have access to the drugs and alcohol and not have any problems, and other people can have the same experiences or even less vulnerability factors working against them and end up with substance use disorders, addictions, et cetera. It’s very confusing. And that conundrum kind of led me to study psychology in undergraduate at the University of Minnesota. And eventually I went into graduate school studying the genetics underlying substance use disorders and the physiology that stems from those genetics, and how come substance use disorders run in families? What are those risk factors look like in childhood? Were you born with a brain that puts you in a vulnerability state, or is it your environment that plays into those things? So I really unpacked a lot of those things in my dissertation and studying brain physiology. And it’s just really an interesting, tough nut to crack, though, for psychologists, for neuroscientists, for clinicians all around. So that’s kind of how I got into this field.
How does EEG work?
Bassi: And that’s one reason why I wanted you as a guest on the show, because of my background in addiction, I don’t often hear of these innovations that involve and incorporate physiology and EEG into the treatment plan. So I think this is really cool thing you’re working on. I think throughout the interview we’ll get sequentially more and more detailed in how it’s all working. So just kind of starting off, when psychiatrists think of EEG, they probably think back of their neurology rotation back in med school when they’re working on epilepsy unit. And I actually worked, did a couple of research projects on EEG back in the day, 2006, 2007. And I know it could be messy, it could be cumbersome, very time consuming and difficult to apply to a clinical setting from that research setting. So tell us a little bit about the broader landscape of EEG: how is it being applied in psychiatry these days and what is neurotype hoping to change about that?
Burwell: Yeah, absolutely. So you’re totally correct. The only way that EEG is typically used in a healthcare setting today, and the only way that’s reimbursed and regulated is for various neurological conditions. So stroke or seizures or epilepsy or other brain disorders that have been around for ages. And EEG itself as a technology is really old. It was one of the first ways that people could study the brain and in a live human being back way back to like 1910 or 1920 in that era, and it’s come a long way since. The stuff that’s still used in hospitals today is fairly cumbersome. It’s designed for neurology settings. It’s designed for people that work with those devices. But in the past ten years or so, people have made EEG much more accessible to lay users. So again, electroencephalogram EEG, it collects the electrophysiology that’s generated by your brain, the currents that happen because neurochemicals are shifting their places inside and outside of neurons. And you know, that’s a really small, tiny signal to record from the top of your head because you got muscles that are in the way that generate also these kinds of noises. You’ve got your eyes that are moving, you got people moving, and these things can all cause noises. And what we’ve been able to do in the past ten years or so is developable electroencephalogram that can get a pretty good read on that really tiny brain signal that’s being generated beneath your skull in diverse places outside while somebody’s moving all these sorts of things. And what we’re trying to do is we’re trying to take that neurology EEG that’s just been limited to a really limited setting. And we’re just trying to step it outside of the neurology clinic into a doctor’s office or a waiting room or someplace that’s not too far out beyond the reaches of where it is currently and make that accessible for the people that treat addictions.
What is brain reactivity?
Bassi: So I know that on your guys’website you talk about brain reactivity and I think that’s a phrase that can really help a lot of patients in the addiction world because I think when they think of their reactivity and impulse control, they think of people, places, things that are surrounding them. They don’t necessarily always think of the biological reasons for their poor impulse control, even though we know TBI and other executive dysfunction elements can contribute to that. I think seeing it in a device is a totally different way of approaching it, way of seeing it, and how it changes throughout the day or months. Tell us a little bit about how that phrase translates to actual data in the EEG world.
Burwell: Yeah, absolutely. So as you say, people, places and things can trigger a person to crave or to eventually use the substance that they might be addicted to, for instance. And when we show people so our platform right now, we use portable EEG headsets and we place that on somebody’s head where they’re shown a bunch of slides of pictures. Some of those pictures are going to be like puppy dogs and chocolate cake, really exciting things like adventure sports. Some of those things are boring things like office supplies, pens and pencils. And then some of those things are drug paraphernalia or people using drugs or places where drugs tend to be used. And for a person with an addiction, for instance, an opioid use disorder. Let’s say someone has developed a dependence on pain pill medication. If they see a pill bottle in that array of pictures, their brain is going to produce what’s called an event related potential or brain response to the presentation of that picture that is much like that of the chocolate cake and puppy dogs and adventures.
Bassi: Totally involuntary that they can’t control. Correct?
Burwell: Exactly. And it’s almost preconscious. I mean, you’re probably aware of it on some level, but it’s to a level of it’s kind of riding under the radar and so we can monitor that multiple times during the course of a recovery or multiple times during the course of a day, even for a person.
Bassi: And what’s the time frame that the ERP actually happens after the stimulus?
Burwell: It happens within the brain response itself starts within 300 milliseconds or about a third of 1 second. So it’s instantaneous, it’s involuntary, like you say. And so it’s unlike other things where you might be able to trick a machine by controlling your breathing or you might be able to trick a machine by thinking of something else. It happens before you’re able to sort of intercept that thing and stop it from unfolding.
Subconscious / preconscious stimuli to cues
Bassi: Incredible, because in med school, I remember when I was working with addiction fellows, they were talking about how we were in the inpatient unit and even putting a tourniquet on somebody or getting Benadryl or even putting an IV in them can almost trigger this feeling of a high in the patient. And I just found that to be so fascinating. So it’s not even the drug itself, it’s all the sequence of events leading up to it. And I think that’s what a lot of patients need to kind of understand in terms of trying to inspect the relapse itself because it’s probably sequence of a number of different stimuli that they experienced over the preceding hours that got them into that mindset of wanting to relapse.
Burwell: Yeah, funny you mentioned it. We talked to somebody, a person that’s in sustained recovery for opioid use disorder and they actually didn’t keep spoons, like dining spoons in their house because it reminded them of their drug preparation, their heroin preparation routine. And they knew that if they saw these certain dining spoons, it would kind of put them on this thought pattern or this behavioral pattern that led them to eventual use. And our goal is to really not like teach everyone to take away all the spoons or anything like that. We don’t want that because I don’t think that’s adaptive or healthy, but make people aware of that so that clinicians therapies can target those things more effectively and monitor those things throughout recovery.
How would it fit into a patient visit to a psychiatrist?
Bassi: Yeah, that’s really interesting. Something that people should kind of know that other people struggle with. So how does it work? So I’m a doctor and I’m working with a patient. Are they going to be wearing the device in the clinic with me and we’re going through a therapeutic session or are they using it outside of the clinic and I’m kind of going over the data with them afterwards.
Burwell: The way that we currently have it set up and we are still kind of doing our feasibility testing and working towards clinical trials, but the way that we currently have it set up is that this would be done. At a clinic, either in a waiting room or by a technician or even a doctor’s office, where the doctors working on some other, like, reports or things that they need to be filling out for that particular patient. And it’s a five to ten minute (procedure). We’re trying to even get that little bit lower scan that we just place the headset on the person’s head and head them a tablet. They watch a bunch of pictures and the report is sent to a cloud. Signal processing and machine learning is applied to that data and then sent back to the clinician. And the clinician can change or make decisions about a person’s care plan depending on that data. Eventually we would like to get to a point where the headsets are affordable enough and durable enough to be taken out of the clinic, thrown in your backpack. You can take it home with you. But at the moment we’re trying to keep things still in a healthcare setting, but not necessarily with all the limitations that a neurology clinic has got you.
What is the underlying biology behind the ERP response?
Bassi: And what lobe is this ERP coming from, generally speaking? Because the way I understand is that we get the electrical activity on the surface. Unfortunately, EEG is very good temporally, but not spatially, and we can’t really figure out the exact nucleus that it’s coming from. But what lobe are we talking about for?
Burwell: You’ve done your research. Yeah, that’s 100% correct. EEG is great for temporal resolution, very poor for spatial resolution. So you can’t make a whole lot of claims regarding where exactly in the brain it’s coming from. Fortunately, the brain sensing the event related potential that we’re focused on is generated really broadly. So it’s generated by the temporal cortex, where there’s memories. That’s a big memory center of the brain. It’s generated by the visual cortex, in the occipital lobe and the parietal lobe for interpreting sensations, interpreting visual stimuli, these sorts of things. And also, there’s some indication that it’s being generated by the frontal lobe based on how attention grabbing it is. These data have been backed up when people have done simultaneous EEG and functional MRI. So functional MRI is looking where blood flows and oxygen blood flows. And so using that together, we know that it’s generated in a lot of places. But for our innovation, we’re not really focused on exactly where in the brain and what sulcus or gyrus. It’s actually being generated because it’s a really difficult thing without knowing how someone’s individual brain folds and how someone’s skull conductivity is different from the next person’s.
Bassi: Totally. Yes. I remember that was one of the difficulties, was mapping, brain mapping and trying to figure out where the EEG electrodes go based on landmarks. But the brain can be a little bit different relative to those landmarks. I have a patient comes in a clinic, we do the neurotype. I get the report, and then it’s almost like a fingerprint for the brain. It’s like doing a blood work, but like blood work, how much control do they now have where they can incorporate that feedback into their next steps?
Burwell: Yeah, so it’s a really good question, and we’re open to new ideas for this, but the way that we see it being used is sort of in an open loop where this is like an A1c for diabetes. Right. It’s feedback about your disease state that a clinician can use to either prescribe new treatment or take a different treatment approach. Some cognitive behavioral therapy is focused on how you handle your triggers. And so the way that could be incorporated, there’s also exposure therapy or types of mindfulness practice that are focused on seeing or handling triggers in the moment. Right. And so if we can make this just sort of feedback or awareness for the clinician to incorporate, they can use that to target their therapy, but they can also use it to track the effectiveness of their therapy over time. And so it’s also kind of like we sometimes liken it to a vital sign or even a fitbit for a fitness tracker for your brain and it’s relation to the addiction that you might have. We are developing digital therapeutic approaches so brain games that kind of help you sort of identify those triggers and then also train your brain to be less impacted by them. But that is something we’re working on in-house and a little bit less further along in the pipeline.
How do you change brain reactivity?
Bassi: Interesting. Yeah. That sounds like it delves into acceptance and commitment therapy wherein you have these thoughts and they are attached to some underlying emotion or feeling and you’re trying to disconnect that feeling from the thought itself. So it could be anything. Going outside can be a trigger that makes people feel very anxious and then you have to come up with some sort of what’s called “diffusing” strategies which is a made up word that the founder of acceptance commitment therapy made up to try to separate the two. Seems like what the digital therapeutic is going to be doing in the future where they’re trying to separate the spoon from the craving, the needle, etc. And just try to make it kind of a neutral stimulus again.
Burwell: Exactly. Yeah. Because you know, when we show people without substance use disorders these pictures, the spoon doesn’t jump out at them. We’re trying to get it to that level again. Right, and another thing I just want to point to is that a big goal of ours is to improve the clinician patient interaction right now there’s a lot of substance use disorder treatment field is old and not a lot of innovation has taken place in the past 20 years there. And we’re trying to take some of the subjective approaches, some of the approaches that for monitoring somebody’s disease state that are viewed as sort of punitive such as urine, drug screens, compliance based assessments and these sorts of things. And we’re trying to make it look like the rest of medicine where there are vital signs and measurement based care is relied on much more strongly.
Understanding biological mechanisms helps reduce stigma
Bassi: Totally. I think that will go a long way in reducing stigma too. I used to give a presentation about the underlying biology of addiction to family members during “family night.” We had family members come in to hear this presentation and they were kind of blown away about how heritable addiction is and how it’s not necessarily totally their fault. And it gets into a lot of discussion about are you intentionally doing this or is this something that’s ingrained in your mind? And I think anything that will start to build support for the fact that there’s an underlying impulse control issue or over reactivity would start to alleviate them from saying, “okay, I not only need to focus on group therapy, and try to be around the right people who are supportive of me, but also kind of focus on a biological level, about what these immediate impulses are going on there.”
Burwell: I think you’re ringing the right bell because, I mean, really, there is so much research that suggests areas where we can improve psychoeducation about the neurobiology of substance use disorders and the genetics of substance use disorders, but very little translation into the clinic has taken place. And I think it’s incredibly empowering and motivating and just inspires hope and patients to know some of these things and that it is a disease and it’s like other diseases and should be managed in such ways.
What will the interface be?
Bassi: So one thing that I have noticed when I use social media is that I can do a video that’s like very scientific and it’s 100% accurate, but if it’s not done well creatively, it doesn’t really get that much appeal to it. And same with certain apps. There are apps out there that are created by government entities that are very good, but they look like they’re made in 1985 and nobody really downloads them. What kind of challenges do you foresee? You have this very scientific background but I think what also set this apart in the field is having something that’s very usable, that’s user friendly, and that people can just easily just dive right into and they get immediate feedback and results. Tell me how you kind of balance the two?
Burwell Yeah, one of the things that’s really helped us I think along the way is just talking to patients and talking to clinicians. The substance use disorder treatment and recovery space is a place where people want to help other people with addictions. But you also sort of need to be accepted into– you need to work with people and understand what they want more than what you want to show them and push on them. So we’re really trying to understand what their needs are, what their pain points are and how this can be most effectively administered to them and attractively administered to them. And so that’s a big reason that we’re focused on cues because we know it’s an area of problem for relapse or recurrence. And so the focus on cues is also really easy to personalize towards people. We’re playing around with different ways of personalizing this. So for instance, right now we’re just using set kind of static groups of pictures. But it’s not beyond the realm of possibility that we could include something from your social media feeds or include triggers that photo. Exactly. These are really some of the creative places that we want to go. The flip side of that coin is we’re trying to build this as a medical device and that requires regulation from the FDA, and these sorts of things are reliant on standardization. So it’s a two way street and we’re trying to figure out where we want to stand on it. But again, I think just getting that user feedback, getting patients and clinicians to tell us what they feel about it and where they see it being useful or problems that they identify with it, is very valuable.
Why is FDA approval important?
Bassi: Yeah, let’s touch on the FDA part just real quickly, because I think it does play a role in what direction you’re going in. And I’ve interviewed a few people now, and one person said that they want to get the FDA approval, obviously opens up a different payer pool, payer population. And then another one said, “we don’t need to, why even bother? It’s not even necessary.” So how are you going to make that decision?
Burwell: It’s something that we have gone back and forth on. One of the reasons that we decided to move towards FDA is because we’ve talked to a lot of providers and many are not comfortable in suggesting something to their patient or even prescribing something to their patient, obviously, unless they have the backing of the FDA. And then on top of that, when we’re talking about something that’s a medical device and something especially like an EEG, which is a little bit more involved than just a downloadable phone app, or just say some other kind of mindfulness app something like that. It costs money for the headsets, it costs money to maintain these headsets. And it’s not like the same prices in neurology, which are really, really expensive, but still it costs money. And so clinicians as well as us, we don’t want the patients to be paying necessarily out of pocket for all these, especially for community based clinics or other places that this stuff is, that a lot of patients have to go for treatment that don’t have a lot of money. And so for something to be reimbursed– in talking to insurance companies, it’s almost required that such a thing is FDA regulated. That’s been our approach. It could always go that we have a couple of versions. One is the regulated version, one is the consumer version.
Bassi: That makes sense. And I could see why it was so difficult for you guys to make that decision because it is kind of up in the air. It is nice as a clinician to know, like Alpha-stim, for instance, has FDA approval and I need to prescribe it. And there’s data there and it’s almost like kind of it takes away maybe some second guessing about efficacy that the patient might have. It’s like, oh, this is actually approved, it must have been vetted very well versus an app, one of 200 apps that are out there that are just out there in the pool. And I’m not really necessarily prescribing it, but more or less suggesting it, like, maybe it’s not really that effective. And the placebo effect can be quite broad in our field.
Burwell: And as you say this, with all the different apps out there, there are definitely ethics standards for FDA regulated therapeutics and not necessarily with anything you download on the app store. Right. People sometimes don’t like surveillance or they don’t like the taste. that shared data gives me some of their mouth. And so I think also going through an FDA process would help us gain that kind of credibility as well.
Bassi: So you mentioned some new features that you’d want to work on after FDA approval. So it sounds like all hands are on deck for FDA approval at this point?
Burwell: That is our current that’s our current approach. We are actively applying for NIH grant. So we already have one NIH grant from the National Institute on Drug Abuse that’s focused on validating early validation of this technology in patients with opioid use disorder. We’re applying for a follow on grant to that. That would be phase two that’s focused on a clinical trial with our technology. And the outcome of that would ideally would put us in good place for submitting an application to the FDA for regulatory status. And so that’s our current all hands on deck, as you put it approach. But there’s so many other fun things that we think of as we move down this pipeline. We talk to people and it’s like, add this to the to do list, right?
Bassi: Yeah, totally. I know sometimes, like, your mind moves faster than the clinical research can handle all the new features and stuff.
Burwell: Yeah. By the time that we learned something new ourselves, we’re like, well, we know that now. What’s the next thing we can focus on before? And it’s hard to just stay the course and just focus on the thing that’s going to get us into the clinics and out the door.
What are some misconceptions about Neurotype?
Bassi: Given everything we said about how it works, have you noticed any misconceptions that clinicians or other engineers or patients have or how it works and what you want to change about those misperceptions?
Burwell: Yeah, so there’s a lot of neurofeedback out there. It’s not a new term. And one of the things that we run up against is that prior neurofeedback has relied on something that’s called QEEG or quantitative EEG. And QEEG, well, it has some merits. It’s incredibly engaging and it’s fun and it’s easily applied. It doesn’t involve looking at pictures. It’s basically the state of the EEG sensors. When you’re just sitting there and maybe you’re practicing mindfulness or maybe you are interacting with your environment in some other way. It’s incredibly easy to bias by things like a person moving or a person scrunching their muscles, like I described earlier. And this has led it to all sorts of pitfalls in terms of being clinically valid. It doesn’t tie well to certain disorders and certain outcomes. Right. And we look like that from the outside, even though our technology is very different from the inside. Right. So you put a head sensor on somebody and you give them a tablet and clinicians immediately think, oh, this is like everyone else’s neurofeedback, which I know has not been validated. It’s failed before in clinics. And so what we’re trying to do is really drive home this point that this is a new kind of neurofeedback, this is the next generation neurofeedback. It’s reliant on event related potentials, which are not biased in those same ways. A muscle scrunch doesn’t screw up your signal, a person moving doesn’t screw up how your brain is responding to pictures on a screen. These are very like, time-locked prespecified brain responses that we can model and it removes all that noise and all that concern that we have with traditional neurofeedback. And so I think trying to nail this point with talking to clinicians and talking to patients and showing here’s something that’s going to be equally engaging and equally enjoyable and insightful, but it’s also going to have some scientific validity to it and clinical validity to it. That’s an important point that I want to drive home because this reliance on biomarkers from event related potentials has just had so much peer reviewed research that supports it versus QEEG, which has been sort of torn apart in the academic space. I don’t want to throw the baby out with the bathwater, though, either. I think there are some definitely good things that come from other types of neurofeedback, but we don’t want to be just lumped in with everyone else, is what I’m trying to say.
How does the ERP change over time with treatment?
Bassi: Right. And as you were talking, it kind of made me think about how I mentioned that it was involuntary and I think that might give somebody the impression that they can’t use this data to help them over time. Have you guys looked how the ERP changes over time with therapy? And if there is hope there for somebody actually using this data to actually get better and start to reduce their reactivity levels?
Burwell: Yeah. So full disclaimer: this has not been in a clinical trial, but just anecdotally we found in people that remain abstinent for a year that there is a significant there’s a reduction in the amount of and this is just a handful of people, mind you, in the amount of brain reactivity to opioid cues and people that remain abstinent for that year. And this is in line with other research that’s been done with people with stimulant use disorder, cocaine use disorder, and that’s peer reviewed published research, I think, in the American Journal of Psychiatry. And there are other studies that have shown that this kind of brain response, if it’s big, it is indicative or predictive of relapse risk. But these are the sorts of things these are our targets for the clinical trials that we plan to conduct in the next year or so. But we really like to test this out in people at different stages of recovery. So people early on, people after six months of recovery or abstinence, people after one year and then also people like five years down the road, people that are sometimes considered recovered. Right. And see how. These triggers are monitored in these different populations.
Bassi: Well, I hope that you guys have an easy time trying to get the clinical trials through the IRB; it seems like a very low risk procedure to do– a low risk device, and it has a high upside potential for it.
Burwell: Yeah, that’s definitely a benefit of EEG. It’s non invasive, it’s fairly easy to apply, and low risk as far as that goes.
What was your biggest surprise?
Bassi: In your journey through this space, what was your biggest surprise, would you say?
Burwell: Really talking to people with addictions, talking to clinicians, there are so many paths for how somebody gets to an addiction clinic or addiction treatment or people that don’t even make it there. Right. People that just develop a substance use disorder.
Bassi: Nodding my head forcefully.
Burwell: Yeah, it’s very eye opening to see it when you’re actually just talking to someone you can hear about in the newspaper, you can read about in a journal article, but when you’re actually talking to somebody about their unique journey, it’s incredibly eye opening. One thing that we have tried to do as we develop this innovation is drive home the point that we might not be for every single case for how multifaceted and how many different ways people get to an addiction. There’s a lot of stuff going on, and we’re trying to treat or trying to address a fairly small slice of this big pie of all the reasons somebody could have a substance use disorder. And there are just so few options out there for treatment. And if we can be one option for one type of person or at a certain person’s step of their journey to recovery, that is our dream. But we don’t necessarily want to– we’re not trying to say that we are the be all, end all of treatment for addictions because there’s a lot of great things out there that people are doing to help people regardless.
Bassi: Right. That’s a good point and a good disclaimer for the listener. We use these words out of convenience, but they mean a very heterogeneous population of people, and everybody has their own story. And I’m a huge advocate for individualized care and approaching every patient based on their experiences of what worked, what didn’t work, what they’re interested in, what they have the resources to do moving forward.
Can this be applied to other mental health conditions?
Bassi: Is the reason that you’re targeting the substance use population because the ERP is more consistent and reliable in that population versus, say, anxiety stimuli?
Burwell: Yeah, it’s all about the cues that we can show people. And so in substance use disorders, the cues are very well defined. Right. It’s drug paraphernalia, it’s people injecting drugs, etc. But, you know, there’s not much of a reason that you couldn’t apply this to other disorders, other psychology. Right. Probably the most research that’s been done with this kind of showing people pictures and seeing how their brain reacts has been done for effective disorders. So depression, posttraumatic stress disorder. Right. People are equally triggered sometimes by, you know, a combat veteran might be triggered by combat related cues. A person with depression that has something called an anhedonia, or like a lack of response to pleasurable situations, has a brain response that’s not as big to the pleasurable cues that they’re shown. Right. And so there’s obsessive compulsive disorder, all these different things that it could be also applied to. We’re really kind of trying to intervene with, especially opioid use disorder for how big of a problem it’s grown to be and how just dangerous it really is. You’ve probably seen the statistic that over 100,000 people died of drug overdoses last year alone, and that number is almost double from it was a few years earlier, before the pandemic. And so this is kind of we’re trying to put the fire out as fast as we could Or, help put that fire out, I should say.
Bassi: Yeah. So I totally see the potential in this and I appreciate you kind of laying out the road map because I do see there’s a number of challenges on your path forward. The FDA approval outlining who this is going to be most useful for, to figure out who your target population is and then figure out how to pair it with treatments, maybe medication or otherwise, to start to actually use the data for meaningful therapeutics and then individualize it for the patient. Yeah. So it’s a really bright future for you. Yeah, there’s a lot of work to be done, which is good for us. It keeps us busy, but it’s also a little daunting. And we can’t do it– I can’t do it by myself. And that’s why I’ve got a great team and we’re trying to build this team, but that takes money too. And we’re also applying for grants to build the team and start to raise capital, et cetera.
Burwell: Totally.
Bassi: But I think 20 years from now we’re going to look back 2022 and kind of sip some tea and listen to this audio and be like, wow, it has come such a long way.
What does the future, in 5 years from now, look like?
Bassi: And where do you see us needing to get in five years in order to get there down the road?
Burwell: Yeah, in five years. You can already see this with digital therapeutics sort of sparking up, but there’s just more options that are starting to come into play, which is advantageous. There’s some new devices, new software devices, new apps and digital therapeutics that are coming on the market. But I think, more broadly speaking, a shift towards measurement based care for addictions. Right. So measuring how somebody is a lot of times throughout a given day or a lot of times throughout their treatment course, and adapting care in such a way that can address maybe vulnerable spots or blind spots. So, for instance, with these triggers, if somebody’s not aware of their triggers, or if these triggers especially provocative to people, but a clinician doesn’t know about it, how is the clinician going to intervene with that person, you know, if the person doesn’t say anything about it? Right. And so if we can measure important biomarkers or important other self report kinds of things that patients might have, we can more effectively target certain symptoms or certain vulnerabilities that patients have. And I think in five years, we’re going to be a lot better suited to do that. And in 20 years, this space is going to be entirely transformed. I have faith.
Bassi: That’s so cool. Well, Dr. Scott Burwell of Neurotype, I really appreciate you being on the show and talking to us about all of the challenges that you’ve overcome and where you see things going in the future. If I had money lying around, I think I’d most certainly invest in you guys. It sounds like it’s going to be just front and center in how we approach addictions with obviously a very set population of individuals.
Burwell: Awesome. Well, thank you, Dr. Bassi. It’s been very fun to talk to you and thanks for having me on.
Bassi: Thank you so much. As a reminder, if you’d like to support the show, one way you can help us is by subscribing to the channel on YouTube and leave a comment if you’d like. It also mean the world to me if you you can share it with your social media network. Maybe there’s somebody out there who might be interested in the podcast. Hope to see you next week. Next Monday. New episodes are released every Monday morning. Thanks a lot. Take care.
Resources
Learn more about Neurotype:
https://www.neurotype.io/
Article on “EEG and ERP Findings in Substance Abusers”:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2746385/
Article on EEG based Neurofeedback:
https://www.frontiersin.org/articles/10.3389/fnhum.2017.00051/full
