Episode 96: Managing Hot Flashes with Hypnotherapy with Claire Hall of Mindset Health

00:01.40
onethingrinde
Claire welcome to the 1 thing podcast. It's so great to have you here.

00:02.96
Claire Hall
Thank you so much for having me I'm excited to be here.

00:08.49
onethingrinde
Yes, um, I'm so happy that we made this happen I know we met earlier this year um when I did a ah webinar for mindset health and it's great to connect with you and and learn more about your work. So thanks for being here. Um I thought we get started just hearing how you got involved with mindset health how you became one of the early contributors to the work. You guys do there and how did that all manifest.

00:43.26
Claire Hall
Yeah, definitely I get this question a lot because ah you know mindset health is is based in Melbourne Australia and as you can tell I am based in the Us and and I am still the only us employee that that mindset health has. And so it's definitely a question that comes up a lot. Um I prior to working at mindset health was working in a neuroscience research lab where I was studying and the effects of opioid use disorder and obviously working sort of adjacently in the chronic pain and pain world. And was very interesting but also um, a little depressing if I'm being honest and and it sort of put me on this journey of researching alternatives to pain management and that's when I sort of came across Hypnotherapy and thought to myself. There is wonderful research in Hymotherapy and I knew nothing about it I didn't know anyone who is providing it I knew basically the the stage hypnosis stigmas that we all know and and really saw this gap in. What was being done in the research world. But what is actually understood from a broader public perspective and and that's sort of how I found mindset health and at that stage it was just Chris na the co-founders and and a couple others.

02:13.42
Claire Hall
Who were working on and at that time it was just the nerva app which was for and a hypnotherapy based app for irritable bowel syndrome and um I linked up with them and and sort of saw the vision of of where this could go and um the the vision of how we could. deliver hypnotherapy in this way pretty broadly and and they asked me if I would jump on board with them and and the rest is history from there.

02:42.51
onethingrinde
That's really interesting so you were in the first ten people being in within the company. Wow amazing! That's ah that must be rewarding to for you and just to kind of.

02:46.77
Claire Hall
Yes I think I was number 4 or 5 so pretty early. Yep.

02:59.50
onethingrinde
Grow and see what you guys have become. Um.

03:03.45
Claire Hall
Yeah, it's it's rewarding. Definitely it's it's a challenge and I I like that and trying to to change the world's perspective on Hypnotherapy is definitely ah, a big undertaking but um, it's it's been really very rewarding as well.

03:18.84
onethingrinde
Yeah, so um, before we dive into what we're we're talking about today's horizon mean topic of menopause and Hypnotherapy applications. Um, can you just give us the rundown of all the different. Ah, areas you guys are looking. You're supporting people with now.

03:37.38
Claire Hall
Yep, definitely so I mentioned nerva and which was our first product which is a irritable bowel syndrome app and with that we partnered with Dr Simone Peters um out of Monash University and really the model of mindset health and what we're doing is partnering with academic researchers who have and a protocol that has been studied and taking that protocol and helping them deliver it to a mobile app format. So that it can be offered and to patients and in in a really scalable way. So the nerva app was our first app and we then partnered with Dr Gary Elkins who's the head of the mind Body Medicine Research Lab at Baylor University and to create the evia app which is and more the topic we'll be. We'll be chatting about more today and but the ev app is for menopausal hot flashes. And and we also worked with Dr Elkins to develop the finito app which is and an app for smoking cessation. So all hypnotherapy based protocols and we've recently released an app working with Dr Michael Yapco um a called Clario which is general mental health and and we are in the works working with um the the neuro and institute in Sydney and developing a chronic pain app as well. So we've got a lot going on. Um.

05:02.88
Claire Hall
Certainly ah, no, no shortage of of challenges across all those different areas and but the idea is taking the areas where there has been substantial research into Hypnotherapy is an effective tool and and taking those protocols that like I said. Are very effective and have been used in clinical trial on a really small scale generally and just because limit limit of access and being able to take those protocols and and put them in the hands of patients all over the world.

05:35.00
onethingrinde
Wonderful. Yeah so I think the ah good next place to go is um to hear your your concept or your kind of personal view of Menopause or perimenopausal transition I know these? ah. This phase of life is viewed differently throughout the world and different cultures experience. It differently. So it's It's hard to define. Um I guess for everybody but I'm just really curious. How how your your view of it is and just kind of what you what you feel. Ah, women are experiencing during that stage change.

06:15.15
Claire Hall
Yeah I think you know I think Menopause is um, misunderstood misrepresented and and you know viewed viewed very negatively in ah, our culture and our society which I feel very sad about and because you know. It's this period of of change and drop and drop an estrogen drop in progesterone that and brings about changes that are viewed so negatively and I think and it's doing a disservice to to the to the human body and the human brain by viewing it in such a negative light. You know. Culturally, we we look at um cultures where there's you know you have a quinceanera in Puberty or you have a Bar Mitzvah a Bat Mitzvah during puberty to celebrate these these changes and and these phases of life that are quite similar to Menopause you know going through puberty you have. This increase in hormone levels that that leads so a whole cascade of changes and it's not dissimilar to to what's happening in Menopause and so just sort of on a basic principle level I think setting the stage that it's Menopause is not. Ah, Health Condition. It's not something that needs to be treated or ah that that people need um to be saved from and in any stretch of the imagination. It really is and a natural life ah change that women go through and.

07:43.35
Claire Hall
Think we can talk about ways to to manage the symptoms that go along with that but just set set setting the stage that it's certainly not something that should be viewed negatively.

07:54.96
onethingrinde
Definitely Yeah, um, there's There's a lot of good resources that I can put in the show notes about empowerment through Menopause and some different views that are um. Being embraced about what? um with this that change of of life stage means and what can what it can mean to the Individual. Um.

08:22.70
Claire Hall
Yeah, 1 thing that's interesting. There was a survey study that was published and you know we often ah associate mood changes anxiety depression during menopause. Certainly there's some, there's symptoms that that happen to coincide very often. And but there was a great study that was published surveying surveying postmenopausal women and looking at and satisfaction with their satisfaction with life in general and quality of life and and during the perimenopausal.

08:47.86
onethingrinde
Um, yeah.

08:53.14
Claire Hall
Early postmenopausal phase. There was a small decline but and actually in that late late postmenopausal period and beyond and women That's the time where women tend to serve it say that they're the the overall quality of their lifetime has been the highest and so I think.

09:09.23
onethingrinde
Hey.

09:11.68
Claire Hall
You know we have these transient periods that we do see changes like I said similar to puberty. There's certainly mood changes that go along with puberty go along with Menopause but and late postmenopausal you actually see satisfaction with life be some of the highest that it's been.

09:28.46
onethingrinde
That's great. Yeah, so I'm curious when you set out to develop Evia like what were the the why questions behind you know the development Like. What was the problem it was trying to solve.

09:44.79
Claire Hall
Yeah, so the problem really you know we know that there is good options for for managing Vasa motor symptoms specifically and that hormone replacement therapy is a great option for a lot of women and not for all women but for a lot of women. It's a great option and. And there's there's certainly quite a few women that it's either not a good option for they don't want to try hormone replacement therapy or you know there's the the edge cases where it's actually weaning off hormone replacement therapy and or or ah alongside and so there's. A lot of women who are sort of left out from from hormone replacement therapy or other options and and the initial study that was done with the evia app protocol was actually in women who were breast cancer survivors so women who were on Tamoxifen. And and obviously couldn't go on any sort of hormone replacement therapy but had quite severe hot flashes and so the original protocol was actually studied in that group of women and and the hypnotherapy group saw a significant reduction in hot flashes compared to the controlled group. So then the protocol actually went on to be brought into being studied in postmenopausal women 187 postmenopausal women was the second study that was done and so you know the.

11:10.57
Claire Hall
I'm sort of beating around the Bush for the why. But I think really, it's just that we know Hypnotherapy is is very effective and it's another option for women and I think that the great thing we can do is and to develop options. You know the the 1 thing that that makes. Menopause feel very difficult or makes any life transition feel very difficult is when you don't have options in front of you and so when we have something that has been shown in the research to be really effective really safe but really inaccessible.

11:34.83
onethingrinde
Yeah.

11:43.90
Claire Hall
I Think it was sort of the no brainer and in bringing this and and bringing this out and giving it as an option to many more women.

11:51.48
onethingrinde
That's great. Yeah, when you were describing the why I was thinking of how many patients I've encountered over the last ten to fifteen years who fit this? um. This situation where either they have a strong family history of breast cancer and they're really hesitant to do any type of intervention with estrogen based products or they've had a personal history of breast cancer and diagnosis is happening earlier and earlier. So um. Some people are getting diagnosed well before they even get into menopause and so it's it's ah often a situation where you know there are other medication options but they're also not appealing um to people and it's it's really nice that there is a non.

12:27.80
Claire Hall
Yeah, yeah.

12:44.85
onethingrinde
Drug alternative like Evia and so I was just thinking of 1 you know, couple of patients that came to mind as you were describing that so that's it's really great. Um, so when when you were developing this like. How did I know that researchers always like to think about mechanisms and you know and have these discussions especially if you're being challenged with like how's this work. Um, as far as like putting the pieces together like what is a hot flash.

13:20.12
Claire Hall
Yeah.

13:21.68
onethingrinde
And how does um Hypnotherapy Modulate Hot Flash like have you gotten that deep into to understanding or is it sort of that story and development.

13:33.97
Claire Hall
So it's definitely the exact mechanism of how Hypnotherapy affects the thermo regulatoratory system is not known. Um and I you know hopefully will will talk in a few years and it will be known. And but at this point it really is not well understood and in terms of the actual mechanism of how hot flashes and why hot flashes occur and the hypothalamus is responsible for and thermo regulation so taking all of the information from all parts of our body. So. And our internal temperature. Our skin receptors send temperature information to the hypothalamus and and then the hypothalamus takes that information and reacts and and elicits a response if necessary. So and if the information that's being sent says that we're we're hot. Then the hypothalamus stimulates a cascade of events that and are intended to cool us down and so we have what's called our thermoneutral zone and within our thermoneutral zone. We're able to and you know manage these small adjustments to temperature that we experience day to day. Ah, in the top of our thermon neutralutal zone is that threshold that would send us into a more dramatic response like a sweating response and and then the bottom of our thermon neutral zone is again that that floor where we would be sent into a more dramatic response like shivering and.

15:06.45
Claire Hall
And what we do know is that during menopause when we do see that reduction in estrogen progesterone that and the thermoneutral zone is narrowed so what used to be sort of a zone where we could manage these and. day-to- day fluctuations and temperature for some reason is setting us outside of that thermoneutral zone and that's what's triggering the hot flash. So we're just unable to respond to these fluctuations and temperature like we used to and it's triggering a sweating response or. An overreactive response to what is what used to be within our thermonute Thermoneutral Zone

15:50.40
onethingrinde
And so estrogen is one of the main hormones involved with that but is are there other hormones like progesterone that could influence it.

16:03.49
Claire Hall
So we don't really know to be honest and Estrogen certainly is the main culprit that we believe to be influencing it and and again it's It's not really understood why Estrogen is influencing and the the thermonotules on we know that? um.

16:13.77
onethingrinde
Move.

16:20.33
Claire Hall
There there is estrogen receptors in the hypothalamus and certainly that that and a reduction in estrogen would ah would certainly and cause some change in the hypothalamus. We know that's where the thermoregulatory system is. And but again we don't understand what the the actual mechanism is there so you know it's step 1 with my research hat on is that there's just so much. We don't understand about ah vasomotor symptoms so much we don't ah understand about the effects of estrogen and not just in the hypothalamus but globally.

16:47.10
onethingrinde
Yeah.

16:56.98
Claire Hall
And and it's certainly an area where there's a lot of work that needs to be done.

17:03.93
onethingrinde
I Think what's troubling or difficult about half flashes is how they um, just kind of arrive unannounced at any moment during the day you know and it's kind of like no warning. And so that's just a very uncomfortable feeling and then for some people they seem to get them. You know later in the day or in bed or what have you.

17:25.68
Claire Hall
Yeah, the one of the you know one of the biggest problems with hot flashes and is and 1 of the biggest complaints is night sweat so hot flashes that are happening at night and and night sweats and and hot flashes but night sweats specifically obviously interfere with sleep quality. And and we know that sleep sleep quality has a massive cascading effect on many other things and so they interfere with sleep quality but also and we you know we look at hot flash on the hot flash daily interference scale. So not just the.

17:51.70
onethingrinde
The earth.

18:03.73
Claire Hall
Frequency and severity of hot flashes. But we also look at the daily interference because and like you're saying you know quality of life is significantly impacted with and with hot flashes that they're unpredictable and they can be embarrassing. You know if it's happening in the middle of a meeting if is. Is going to happen to me on the podcast I turn all red it be very embarrassing and and I think it's just something that is is underplayed in terms of equality of life impact for for women.

18:33.34
onethingrinde
Yeah, and you know, especially I think um, you know if say ah a man has never experienced one is they're not going to offer much compassion or empathy. You know to. Partner or spouse you know it's this kind of like it's not a lived experience. So um, you know luckily there's a lot of support for people who are struggling with menopausal symptoms. But I think that's 1 thing that's um, I've been fortunate enough to you know help lots of women. In this phase of life and I see what it does to their mental health and how troubling it is I think it's really important for people to love ones and people to know that it's just it's just such an uncomfortable feeling and to to deal with and it really throws off your sense of equilibrium and balance. And yeah, so I'm glad you mentioned that and.

19:27.66
Claire Hall
Yeah, one of the reasons that why it's so challenging to to study into research Menopause more generally and is that you know it's so hard to tease out symptoms and tease out these these responses because you look At. Increase in anxiety and depression during Menopause and you know that's pretty well understood in in a lot of women but there's also oftentimes a decrease in sleep quality and an increase in these quality of in hot flashes causing a massive impact on quality of life. So It's it's oftentimes. So hard to tease out what's causing what and and just makes it ah ah a challenging thing from a research perspective to study. Um, but certainly doesn't doesn't downplay the effective of the implications of it because certainly um is.

20:12.30
onethingrinde
Never.

20:22.47
Claire Hall
Is a quality of life impact for sure.

20:25.44
onethingrinde
Yeah, definitely lots. Lots of research going into Estrian's effect on the brain and you know so we know ah that that information's on its way. So I think we're we're learning more and more about Dopamine serotonin.

20:36.56
Claire Hall
Yeah.

20:41.99
onethingrinde
Um, all its relationships with estrogen.

20:44.46
Claire Hall
Yeah, 1 thing that isn't talked about often but I find it quite interesting is that um I believe the figure I think it's 25% of women experience hot flashes during pregnancy as well and you know it's it's.

20:55.62
onethingrinde
E.

21:01.14
Claire Hall
1 of those things that again talking about the relationship with menopause to puberty. There's also our relationship to pregnancy and and there is obviously you know seeing that that hormonal change and does interfere with thermal regulation and and we see that with. Ah, small proportion of women during pregnancy as well.

21:23.34
onethingrinde
Um, that's interesting. Um, so when when you're looking at Hypnotherapy um I think for for the. Different types of researchers I've heard and I'm I'm most familiar with your work with nerva and the way that you describe how Hypnotherapy works with the mind gut access how how do you think Hypnotherapy is helping um, is it. More from a standpoint of prevention or is it more from a standpoint of management of hot flashes or is it. Both.

21:59.12
Claire Hall
So the interesting thing about Hypnotherapy I'll back up I'll talk about Hypnotherapy more generally and then I'll answer your question so be interesting with hypnotherapy that is different compared to other psychological therapies and is that you know.

22:05.97
onethingrinde
Means.

22:16.20
Claire Hall
If we look at it compared to something like cbt cbt is is highly effective for for a lot of different conditions and including Vasomotor symptoms. It is shown to have some effect on vasomotor symptoms and. And the the main difference is that with cbt really is focused on improving the perception and response to and the the stimulus. So if we're talking about it from the perspective. We'll just say pain generally.

22:45.43
onethingrinde
And.

22:46.99
Claire Hall
So pain generally you're managed. It's it's helping you manage or cope with pain and and reframing that using cognitive reframing to and increase your your ability to to manage and deal with any amount of pain. With Hypnotherapy the difference that we see is is quite interesting that it's not just and helping manage or cope with pain. It's actually ah changing our perception of pain and so we see with Hypnotherapy that and when you actually reflect back on the stimulus it. It. Ah, patients who have done hypnotherapy versus cbt and are tend to say that the actual stimulus itself was less um, not just that they were able to manage it better and so that was very abstract but I'll talk specifically about and about. Hypnotherapy for vasomotor symptoms is that we don't believe that it's just helping women manage the symptoms better. We really do believe that and and it's supported from from the research that we see is that it really is and. Turning down the frequency and severity of hot flashes for women and so you know in the studies that we've done we look at not only the self-re reflected frequency and severity. But and in Dr Elkin's in-person trial. He did with postmenopausal women. He actually put.

23:57.93
onethingrinde
E.

24:14.57
Claire Hall
Temperature sensors on the skin of women and and it was shown that not only like I said the self-reflected self diary of frequency and severity was improved but actually the temperature sensing on the skin showed fewer hot flashes during the day and so.

24:29.56
onethingrinde
Well.

24:32.66
Claire Hall
There is an effect with hypnotherapy that we see it's It's actually an effect on reducing the the instance of hot flashes and and you know we think it has to do with and some sort of neuroplasticity of being able to. Helping the brain adapt to this new lower level of of estrogen and again we don't understand that mechanism I Wish we did and but it has some sort of neuroplastic effect of helping the body really manage this new lower level of estrogen.

24:51.32
onethingrinde
Any.

25:06.29
onethingrinde
Very interesting. So for people who are new to Hypnotherapy or ah your the type of hypnotherapy that's used in evia what what are they doing and what are they experiencing during the sessions.

25:19.53
Claire Hall
Yeah, so a clinical hypnotherapy session and is is not the state hypnosis. We all think of certainly not the swinging stopwatch and clinical hypnotherapy is. And a therapy that's used that sounds a lot like a guided meditation for the actual experience of it and and the the theory behind it is that at the beginning. There's a progressive relaxation tool. Um, ah, an example of one that we use is ah progressive body scan so starting at the top of the head. Going to the tips of the toes and and that's really getting the the patient or the user into a deeply relaxed state and so with Hypnotherapy you're never asleep or out of control or and unaware of of your faculties. You are just sort of in a deeply relaxed state. And and then within that deeply deeply relaxed state. The next part is a and guided meditation like um like portion. So within the evia app that middle portion is and guided meditation really focused on coolness. So 1 of the sessions is ah called the snowy mountain path and so guided imagery of walking on a snowy mountain path and then the the suggestions really are around and which is that therapeutic component giving suggestions around coolness and.

26:32.70
onethingrinde
No.

26:47.51
Claire Hall
And being able to feel that coolness in the breeze on your skin and and and really giving suggestions that women are in control of their temperature that there there will be no more hot flashes. You'll be in control of your temperature and be able to manage these symptoms. Um. So the the way that hypnotherapy the the main therapeutic components are that progressive relaxation technique getting women into a deeply relaxed state and then the guided imagery with the therapeutic suggestion so and having the ability to. Um, give suggestions while patients are in a deeply relaxed state where they're more open to feeling those suggestions in their bodies feeling what that feels like without the initial like no response that you know if you if I if I say to someone who's having 7 hot flashes a day and that they're. <unk> feel cool. They're going to be in control of their symptoms. They're gonna say no I have seven hot flashes a day and that's not the case for me but within a session where they're deeply relaxed. They're imagining using that imagery of being on a snowy mountain path feeling that cold breeze on their on their face. You're more open to suggestions.

27:47.55
onethingrinde
Yeah, yeah.

28:03.63
Claire Hall
That you're able to be in control and able to go back to that normal that thermon neutralral zone that you're used to.

28:11.90
onethingrinde
Yeah I really like how ah mindset health has understands that that first layer of resistance. Um is there and that there's a process of kind of letting in this messaging.

28:26.16
Claire Hall
And that's that first layer is there for a reason right? You know that's it's really and it's not that's not wrong. That's there for a reason because if we accepted everything we heard then and we you know we wouldn't be. We wouldn't be good functioning human beings.

28:28.90
onethingrinde
Um, yeah.

28:43.24
onethingrinde
Yeah, yeah, yeah.

28:45.81
Claire Hall
So it's there. It's protective for us. It's there for a reason and and you know using Hypnotherapy in a clinical setting. We we get people into a relaxed state in a really safe setting and offer suggestions for therapeutic improvement. Only.

28:58.00
onethingrinde
Yeah, yeah, reminds me of in my twenty s I was living in San Francisco and I went to this breathing class. Um, it's like supposed to be for healing and health and um.

29:14.58
onethingrinde
They they had us lie down and um, the instructor was walking around whispering in our ears and I was not receptive so that was not therapeutic for me. So I you know quickly got up and left.

29:26.85
Claire Hall
Well well, it's funny I'll tell you a funny story of when we started out with and with the nerva app is that you know what you're describing is that I think whispering in the ear might be an extreme example. But. The voice actually really matters for people to actually to to feel connected to what they're listening to and when we first released the nerva app and we had Dr Simone Peters voice as the recordings and we got all this feedback that that patients. Didn't like the voice and so we had a really hard conversation with her that we were going to have to replace her voice in the app because people weren't responding to it and weren't connecting to it and so we ah we now have a wonderful voice actor who is coached by Dr Peter who's coached. But.

30:05.78
onethingrinde
Oh yeah.

30:17.97
Claire Hall
And it's you know the voice does matter for you to feel deeply relaxed and engaged with the sessions. Um, but it's funny. Yeah, that's that was a tough conversation to have early on.

30:22.30
onethingrinde
A.

30:29.44
onethingrinde
I bet. Yeah, it's ah um, yeah, it's difficult to hear that. But I think you know we have these connections to sounds and just feelings of safety that need to be there and. I'm really glad you guys understand that because um I could see people would just walk away if they if that wasn't part of the process that that definitely would be I can tell you from Firsthand experience that is not good.

30:52.49
Claire Hall
If we were whispering in people's ears I don't think the odds of fact, no.

31:03.54
Claire Hall
Ah, we'll make note of it. We won't do it are.

31:05.84
onethingrinde
Okay, yeah, it's kind of hard to do through an app but I'm sure someone could do it? Um, So ah, what kinds of results are you seeing in in your work like are you at a point where you've gathered lots of um. User experiences.

31:24.38
Claire Hall
Yeah, so you know we're we're doing a lot of work across all the apps and ah with the ev app we actually just published um a paper that was looking at 10000 of the Evia users and describing characteristics of the users. So.

31:36.80
onethingrinde
Wow.

31:41.86
Claire Hall
And the median age and and a lot of different characteristics around symptomology and and and quality of life sleep impairment and we're about to submit for publication another study looking at actual results a ebia and. We see about 70% um of we see 70% of evia users and have a clinically significant improvement in vaso motor symptoms and so we see a pretty pretty significant response. Um through the program itself. It's five weeks long and so it's not ah. Not a program that is long or intensive really in any way of course 15 minutes a day always feels intensive but and you know 70% achieving clinically significant reductions in vaso motor symptoms is and you know. On par with and and certainly and in the conversation with any other any other treatment for Facebook Motor symptoms that exists.

32:40.23
onethingrinde
Oh yeah.

32:47.27
onethingrinde
Definitely yeah, this is a little off topic of that question but maybe helpful to know is um and it might not be available. Is there a particular um phenotype of person. Um. That's going through Menopause that was more likely to have hot flashes or more likely to respond to hypnotherapy.

33:13.21
Claire Hall
So from the predictors of response that we've done We haven't been able to identify that I will tell you that and previous to the ev up and it primarily had been studied in postmenopausal women. And from a research perspective that makes sense because at that point there is and no more variability in Estrogen So and the results really do um ah are correlated with the the intervention. Not any fluctuations and estrogen in the study participants.

33:35.90
onethingrinde
Is a.

33:46.63
onethingrinde
Then.

33:48.34
Claire Hall
So there was some and question of whether or not in perimenopausal women that um that you know it would be as effective and what we've seen from the Eva User App Data is that there's no difference if it's perimenopausal versus and postmenopausal which is great news. Um, you know I think the from the from the perspective of when is best to start Hypnotherapy. It can be started. We know it's it's an effective tool even before hot flashes begin and so you can actually start it as a preventative measure. Um.

34:19.76
onethingrinde
You know.

34:26.68
Claire Hall
And it doesn't seem to matter when it started whether it has an effect so you know not great predictors of response. But um, it hasn't seemed to me to make a difference from the the research that was done. And clinical setting versus research that we've we've published with the app.

34:47.90
onethingrinde
Yeah, and the great thing is is you know there's not this long list of potential harms or complications or risks you know it's just if it helps it helps if you know it's not going to cause more harm for trying versus with ah.

35:01.72
Claire Hall
Yep.

35:04.10
onethingrinde
With hormone replacement therapy or other interventions. You know we're always going through lots of pros and cons and weighing those types of risks before starting.

35:11.71
Claire Hall
Yeah, you know and it's interesting. We don't see the same response really with Evia with evia most of the users. You know I hesitate to say all because I'm sure there's an exception here or there but you know there is.

35:25.75
onethingrinde
Me here.

35:30.32
Claire Hall
The vast majority of users see some reduction in hot flashes and with with Nerva and the ibs program there is a percentage of non-responders and that we don't see that carries over to Hypnotherapy for vasoMotor symptoms. And with the non-responder percentage in the Nerva App. It's about 15% are and don't see any any improvement in their symptoms and within that 15% that don't see any symptom improvement we still see peripheral benefits and reduction in anxiety reduction in.

36:02.67
onethingrinde
A.

36:04.50
Claire Hall
Depression reduction in stress and so on the contrary to having those discussions around and you know the the pros and cons of starting a ah different ah pharmaceutical Intervention. You know, even with patients that don't see Symptom Improvement. We still see improvements in anxiety and depression and so. That's really a win-win to Me. Of course we would like everyone to improve but and you know you're not dealing with these adverse side effects you're you're actually seeing peripheral benefits Even if it's not working.

36:37.26
onethingrinde
And with your research. Do you subset out people who are doing other therapies and this is layered on top and people who are doing this as a Monotherapy um is that is that something you know.

36:49.33
Claire Hall
Yeah, so we ask that? um and in the manuscript that we're submitting for publication soon. Um, we'll tease it out so that we'll be able to look at and what you know if it's a standalone or combined with other therapies and and and I Think. What I can tell you is it. It doesn't quite.. It doesn't really matter if it's a standalone or combined. There's ah improvements across the board and the the interesting thing will just be looking at the degree of improvement and and I think that's that's something that everyone will be interested in.

37:10.55
onethingrinde
Sure.

37:25.96
onethingrinde
Okay, great. So you and I were sort of joking offline. Um, before we talked about some myths and 1 of them was like is layering really something that is is a good thing to do. When you're going through menopause so like wearing you know a vest over ah a blouse and then kind of slowly kind of taking disrobing different um layers as you experience hot flashes so you were saying that that might be a little bit of a myth.

37:57.62
Claire Hall
Well so the myth is you know the myth really is that and that controlling your your room temperature is and you know the then want in the the need is that a lot of women will. Turn the air conditioning up make it really cold and and and feel that that is going to prevent hot flashes and it's actually quite the contrary and this is one of the first pieces of education we give in the app just around a lifestyle modification and that you know if we go back to talking about that thermon neutral zone. Any spike out of that is is actually you know affecting you know if you spike down too far then you're actually going to come right back up the other side and so the best thing you can do from a room temperatures perspective is try to keep your temperature as ambient as possible. So if you're. Bundled all up and then shedding layers and then putting them back on. That's actually really not helpful and and the best thing you can do is you know as but as best as you possibly can try to keep the temperature of your surroundings really as ambient and as possible. So i'm. You know if if you're going inside and outside layers might be the option ah to to keep an ambient temperature but really and trying to sort of artificially lower the temperature of your surroundings and to to stave off hot flashes is um is um, it's a myth and.

39:31.21
Claire Hall
And trying to keep as ambient of the temperature is is actually far better.

39:33.92
onethingrinde
Very nice. It's good to know so that'll be deleted from my handout for for all my patients as of today.

39:41.98
Claire Hall
Yeah, no it. It actually happens most often at night and we see you know you see a lot of women who will put a big fan right next to their bed and what that does is you know you'll fall asleep and you'll pull the covers on top of yourself and cocoon in because.

39:51.42
onethingrinde
A.

39:58.32
onethingrinde
Yeah.

39:59.92
Claire Hall
You've got this massive fan making you cold and then ah being covered in your blankets. So tightly will trigger a hot flash and so really the best thing you can do is try to keep that room temperature very ambient.

40:05.78
onethingrinde
Okay.

40:12.96
onethingrinde
Nice, Okay, well, um, this has been really informative. Thank you? Um I'd love just to hear some just take home messages and just any thing you'd like to share about where where you're headed with things and. Anything else that you'd like to kind of impart us with.

40:28.91
Claire Hall
Yeah, so I'll talk a little bit. You know one thing I I Love to talk about with our what we're doing at Mindset Health is and is sort of our vision for for how research should be conducted In. And a digital therapeutic landscape you know, digital therapeutics and at-based programs are pretty new and it's it's something that because it's so new I think the the whole research world is scratching its head a little bit on how to proceed and and and what. How we should go forward with publishing research and the decision we've made at Mindset Health is that we are not only going to publish randomized clinical trials which is obviously the gold standard and but we also really want to publish real world user data and so. What we've done is not not only just done clinical trials but also retrospectives that and that show patients and and show users and in an actual real-w world app using setting and so why this is important is that in a clinical trial setting. Everything is controlled. So. As we talked about just a minute Ago. You know, ah in a clinical trial setting. You wouldn't have ah patients who are taking hormone replacement therapy or taking supplements taking herbs. It would all be controlled and that is very important to understand and will continue to do clinical trials. But.

41:50.31
onethingrinde
Right.

42:02.40
Claire Hall
There is also the real world aspect of how are people engaging with this in a real setting. You know you are taking different herbs and supplements. You are doing different things and that is okay and not everyone is a research participant who can perfectly control their lives and so.

42:07.48
onethingrinde
Evening.

42:21.57
Claire Hall
We've made the decision for all of our products that we're going to do clinical trials. But we're also going to publish the real world data and and we encourage other other digital therapeutic companies to do the same because and you know we just find it's That's the responsible thing to do if if you know. If we can show these work in a clinical trial setting. We We should really also show that they work for people day to day and that and and that it it is something that is effective outside of that that clinical setting as well and so that's sort of our mission from ah a research perspective.

42:44.85
onethingrinde
I Love that.

42:57.91
Claire Hall
And we'll continue to do that across all of our products for sure.

43:02.56
onethingrinde
That's so great I think it's really important because um, if we're just relying on. You know, Gold standard research to see if something's going to be helpful for someone or missing a whole population. You know that might respond.. It's always great to have both right. Kind of have these 2 worlds to kind of compare. Um real world.

43:21.86
Claire Hall
Yeah, and we also we miss the you know the user ability of it I think what other some other digital therapeutic companies are doing is that they'll publish the clinical trial data but then you know the. In a clinical trial. You have a research coordinator who calls the participants every day or every week to make sure they're actually complying with it and and a protocol that can be perfectly effective in clinical trial. But then in in actual in in real use out in the world. You know if you don't have someone calling you every day you're not doing it and and if you're not doing it then it's not working and so we publish we even publish our the and adherence data because we want to we really feel. It's important that if people don't enjoy it and they're not doing it. It doesn't matter how effective.

44:14.12
onethingrinde
Yeah, exactly.

44:16.68
Claire Hall
The protocol is that that that really is an important aspect as well. So you know making sure that the programs are are enjoyable to actually go through and has an out has an impact on outcomes has an impact on Symptom outcomes for patients. So that's that's part.

44:35.13
onethingrinde
That's so exciting. Yeah so great. What we can do now with you know with these apps and just interfacing with people so much easier and collecting data. Ah data is so much easier. So um.

44:36.48
Claire Hall
Yeah.

44:49.17
onethingrinde
that's that's outstanding um I really really like how you explain that so well this was wonderful. Um I think you know what I'll do is make sure people know how they can download the app and they'll put that information in and and um I can save you know. Many of my patients are using nerva as we speak and it's a big part, a big tool in my management of digestive health with my patients and this is going to be great to start to have my um perimenopausal and menopausal patients. Also. Plug into Hypnotherapy is you know you're giving giving such a guidance to the nervous system with it and you know otherwise you know people don't really know how to guide their nervous system through all this and Hypnotherapy is a great guide.

45:43.53
Claire Hall
Yeah, um, feel free to put my contact information. Um out there as well. I'm more than happy to answer questions I love answering questions about this stuff. Um. And all of our apps are available in the app store in Google play. We have more information at Mindsethealth.com and for healthcare providers and for patients and if you're a nerd like me and you want to dive into the research. That's all there as well. And. And like I said any other questions more than happy to answer? Yeah Thank you so much. This is great.

46:13.79
onethingrinde
Excellent. Thank you so much Claire.