Category Archives: CES Research

Neurotherapy for Post-Traumatic Stress Disorder

Microamperage stimulation on cranial and other acupuncture meridian has been found to be a very effective method for potentiating neurotherapeutic treatment of a variety of disorders.  Stimulation has been found to be particularly useful with disorders that are characterized by deficiencies in brain activity in the occipital regions.  Research in our practice has also shown that stimulation of particular points enhances the amplitude of slow frequency brainwaves.  Our research has also shown that cranial stimulation markedly increases information retention.

There are many patterns associated with many different diagnoses which are well beyond the scope of this chapter.  The point is that some problems have specific neurological patterns and the treatment of these problems is to normalize those brainwave patterns.

Like many conditions, there are several brainwave patterns associated with various manifestations of PTSD.  First, one usually finds a severe deficiency in the ratio of Theta brainwave amplitude to Beta amplitude in the back of the brain.  This pattern, also found in genetically predisposed alcoholics, is associated with poor stress tolerance.  The Theta/Beta ratio in the occipital region of the brain should be between about 1.80 and 2.20.  When that ratio is low, say .70, the person has difficulty finding peace in his head, has poor stress tolerance, predisposed to anxiety and often sleep disturbance.

I believe that this deficiency is an enabler for PTSD so that if a number of people all experience the same trauma; only those with this severe deficiency would be prone to develop frank PTSD.  The others may have some psychological disturbances, bad dreams, etc but they don’t become incapacitated by PTSD.

In addition to this deficiency, the other brainwave pattern that I discovered while treating many of these patients was that they did not show any Alpha response.  The Alpha response is a visualization response.  At locations over the top of the head and in the back of the brain, when the eyes are closed there should be a large increase in the amplitude of the Alpha brainwave band.  Alpha brainwaves are between 8 and 12 Hz and it is a visualization response.  The jump in Alpha amplitude should be above about 30% on top of the head and more that 50% at the back of the head.  PTSD clients have no Alpha response, in fact, it usually goes negative (i.e., less amplitude with eyes closed relative to eyes open).  Now given that Alpha is the visualization brainwave in these locations (e.g., one can increase Alpha amplitude by imagining a sailing ship going over the horizon), lack of such a response makes sense.

The major negative effects of PTSD are the visual flashbacks in which the patient relives the trauma.  Blocking of the visual response should raise the threshold somewhat for these flashbacks.  The problem with such a blocking mechanism is that it also affects other things as well including memory, cognitive functioning and sleep.

There may be some other brainwave anomalies as well but I have found the above two in every case of frank PTSD.  The neurotherapeutic treatment of PTSD, therefore, always includes correcting the deficiency in the Theta/Beta ratio and the blunted Alpha response in the back of the brain.  For cases of traumatic stress that may affect anxiety and sleep quality, I have found that the deficiency in the back of the brain is not as marked as in cases of PTSD.

There are several psychoneurotherapeutic techniques for increasing the Theta/Beta ratio in the back of the brain.  Clients with PTSD are likely to be heavily medicated which severely compromises efforts to normalize the brainwaves in the back of the brain.  First therapeutic goal therefore is to make it possible for the client to start the titration process to wean themselves off the medications.  CES plays a major role in this phase of treatment.  CES increases the amplitude of slow frequency activity in the back of the brain.

A client I will call Jim diagnosed with PTSD was in and out of hospital for years when he finally arrived at my office.  A former policeman who had been traumatized on the job, he was required to be in treatment by the courts after he had used an unloaded gun to threaten a noisy youth at a rally. A day patient at the hospital, Jim came to his first visit with his wife.  The whites of his eyes were blood red, he was sweating profusely and he looked as though he was about to explode.  Jim said that he was experiencing multiple flashbacks every day and that he was very worried that he might lose control and become violent or self destructive.  Jim was heavily medicated but he claimed that the medications “didn’t do a damn thing” although Vivian said that without the drugs he was worse.  She further added that Jim had been through many programs and treatments for the PTSD but none seemed to help and that he was “getting much worse lately”.

The initial brainwave assessment indicated a marked deficiency in the back of the brain, the trauma signature and the pattern for emotional volatility.  The Theta/Beta ratio at the back of the brain was .57 (normative is 1.80 – 2.20), the Alpha response was negative (Alpha amplitude was 14.4% less under eyes closed condition whereas it should be above 50% in that area of the brain) and the Theta amplitude in the right frontal lobe was 33.5% greater than the amplitude in the left lobe.

Jim was under treatment for about a year and received more than fifty sessions.  After 22 sessions, Jim was able to tolerate the CES electrodes on his ears at which time the flashback frequency started to decline markedly.  The Alpha response likewise started to emerge around this time as well and Jim started to make substantial progress in his psychotherapy sessions with his primary therapist.

As the case of Jim illustrates, CES stimulation can be of significant benefit in the treatment of conditions in which there is a deficiency in slow frequency brainwave amplitude in the back of the brain.  This increase in slow frequency amplitude can be obtained with the CES electrodes either on the earlobes or on acupuncture point P6.  The beneficial effects of CES for sleep disturbances and anxiety is most likely the result of the increased Theta amplitude.  In addition there is also a form of depression that is associated with the Theta amplitude deficiency in the occipital brain region that is characterized by more of a burn-out feeling rather than frank sadness.  I have found that the CES is particularly effective for this form of depression.

Microamperage Electrical Stimulation as an Adjunct in Neurotherapy

Paul G. Swingle, Ph.D., R. Psych. [Private Practice]

A Summary Look at CES Studies Of Depression

Eighteen studies were analyzed, in which a total of 853 patients were treated with cranial electrotherapy stimulation (CES) for depression. The patients had presented with various clinical syndromes, of which depression played a major part. The treatment outcome depression scores were combined statistically in order to get a more confident look at the effectiveness of CES for treating this condition. While many of the studies were of the classic double blind protocol, others used either the single blind, the cross over design or were open clinical trials. The result of the analysis showed that the overall effectiveness of CES was 47% improvement. The results indicated that various types of depression, which accompany a wide range of clinical syndromes can be expected to respond, sometimes dramatically to CES treatment.

The goal of clinical studies is always to first test the effectiveness of a potential treatment and secondly to discover which patients the treatment may be most effective in treating. Meta-analysis has the effect of allowing researchers to essentially study a larger number of patients than can usually be assembled for a single study, and the larger the combined study sample, the greater is the confidence that can be placed in the study outcome: that the study findings are true and accurate. Also, the more diverse the study group is in the combined sample, the more confident one can be in generalizing the study outcome to larger groups of patients outside the study. That is, it increases the range of potential types of depression patients that we can predict will be effectively treated with CES.

In the table below is a summary of 18 studies that were combined into the meta-analysis reported on here.

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a Correlation scores, representing percent improvement, are obtained mathematically from the study outcomes presented by the authors. Scores such as percent change scores, the statistical probability scores reported, F scores, t scores, and the like, are changed to r correlation scores and then into Zr scores. That is because percent improvement scores can not legally be averaged. The Zr scores are then averaged and converted back to percent improvement (effect size.)
b Most of the rating scales, both by the patients and the clinicians were of published reliability and validity. In many of the studies, more than one measure of depression was used. In those cases, the average of the results was calculated and reported as the overall result of the study.
c Effect size, here, is a statistician’s basic estimate of the overall percentage improvement by the patients as a result of the treatment


In many of the studies, depression was but one symptom within a larger presenting syndrome. For example in many of the patients, fibromyalgia was the presenting symptom, while in another large group of studies substance abuse (drug abstinence syndrome) was the presenting diagnosis. The presenting syndrome or type of patient is given in column three of the table. In all of the studies, however, depression was a major diagnosis within the presenting syndrome or group.

In the open clinical study, the patients know they are being actively treated for their depression, the clinicians know who is being treated, and the statistician who summarizes the study data also knows, since there is only one group of patients.

Cranial Electrotherapy: Possible Mechanisms of Action

When a new medical treatment comes on line, there is pressure to explain how it works. While CES has been in medical use for more than 60 years (it came into being as “electrosleep” in Europe in 1953), there has been no definitive, settled explanation of its mechanism of action. Some of the theories that are more or less active at present are as follows:

The Nervous System.

The major present concept is that the body functions via a more or less hard wired nervous system. In this theoretical system, the body is neuronally wired to receive incoming stimuli via its afferent neurons, send them to the central nervous system, which then sends out response stimuli via its efferent neurons. One touches a finger accidentally to a hot surface and the finger is immediately jerked away from the hot stove, for example.

Since the neurons don’t ordinarily physically touch, the neural wiring functions via synaptic endings on the neurons in which the pre synaptic membrane discharges neurochemicals from stored vesicles into the synapse between the neurons and these stimulate receptors on the post synaptic membrane (the receiving membrane of the neuron next in line to fire) and that neuron fires the next neuron or the sensitive membrane on a muscle receptor, and so forth.

To work as efficiently as it was designed to work, all the neurons must be intact, and all the neurochemicals that are involved in the neurological firing patterns have to be in balance with all the others. If one neurochemical is out of balance, either it over fires or under fires the system for which it is responsible, in which case physical or emotional symptoms of one kind or another arise. For example, if there is not enough dopamine, Parkinson like symptoms develop. If there is not enough serotonin, depression results, etc.

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Acupuncture Theories

Energy is known to flow through the collagen connective tissues of the body, and some areas of the body are more sensitive to energy incoming to that system than others. These sensitive areas are known as acupuncture points, and CES may well supply energy to that system, though not necessarily by stimulating those points directly.

CES electrodes are placed at various places on the head so that the stimulating current is allowed to pass through the head. CES current has been shown to spread around the head and scalp while also going through the entire brain, though canalizing alongthe limbic, or “emotion” brain.

As anyone knows who has placed CES electrodes on the mastoid processes behind the ears and turned the current up, one tends to get an involuntary grin when the current spreads to the facial muscles, and similarly, there can be light flashes keeping time with the CES pulse as the energy passes through the ocular apparatus in the eyes. For this reason, it is very likely that any acupuncture points on or about the head would receive sufficient stimulation, wherever they are located, to respond to CES stimulation. For example,in some therapeutic strategies, several of those points on the face are said to be dramatically activated by merely softlytapping on them with the finger tips.

Read more – Cranial Electrotherapy Stimulation, A Monograph By Dr. Ray B. Smith, Ph.D.

Common Applications of CES (Cranial Electrotherapy Stimulation)

Granted these exceptions, CES proves effective in many applications. In the western culture depression and anxiety seem the most common psychological problems of normal people in normal life. In both cases, clinicians distinguish between reactive and obscure pathology.

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Reactive pathology grows from an event. People feel anxiety when loved ones might die, and depression when bereaved. We label such normal feelings pathological when they persist past social norms and prevent normal productive behavior. In the Eastern culture flow of an improvement in oneness realization and improvement of chi and mastery could be emphasized. This would of course include an improved ability to learn and do.

In the western world obscure pathology has no apparent relationship to any specific event. It generally has a longer history and takes longer to respond to therapy. CES can alleviate reactive depression or anxiety in about a week with one forty-five minute session per day. More severe depression and/or anxiety requires three to five weeks or more of one or more forty-five minute daily sessions in its amelioration. In the Eastern world effect would likely be seen as an improvement in capacity or a strengthening of chi or vital force can be often immediately experienced with CES but can certainly take four to six weeks or longer of regular CES usage.

Other Therapies with CES

Many individuals receive CES as part of additional treatment programs. They usually enter the treatment program as a result of living in an environment that over stressed them. Their coping mechanisms, both physical and psychological, have failed. Typically, these patients receive therapy, stress reduction and stress management training.

During the course of treatment for outpatients, or following treatment for inpatients, they enter a non-therapeutic environment. This often requires some initial support. CES can has proven useful for preventing a recurrence of pathology.

People can learn more quickly when their being (at different levels) is improved. People can heal and learn much more easily when free from stress. The stress response makes any but the most immediate and reflexive learning difficult. Learning relaxation despite stress has proven particularly difficult. This difficulty also blocks healing. CES can free us from the effects of the stress response. We can learn anything, especially relaxation, better and faster.

CES Use in an Adult and Adolescent Outpatient Population

A Clinical Report on CES Use in an Adult and Adolescent Outpatient Population

By Charles McCusker, Ph.D. & Ray Smith, Ph.D.

 This paper reports the clinical results of using Cranial Electrotherapy stimulation (CES) with clients in an outpatient treatment program.  It presents clinical effects of CES treatment.  It does not present a statistical analysis of data.  The typical intervention time ranged from thirty to forty days.

CES has a record of alleviating depression, anxiety, and insomnia.  CES treatment typically consists of small bursts of energy that pulse across the head 100 times per second with electrical anodes place between the cranium and mandible or on the ears.  The CES device is the size of a standard paperback book.  It produces a modified square wave AC current with a 20% duty cycle.  A dial allows the user to raise the stimulation intensity from zero to 1.5 mA (milli-amperes).  A nine volt battery supplies the power.

This study took place in an outpatient treatment program.  The patients had received diagnosis of dysthymia (depressive neurosis) or major depression.  Many had associated sleep and anxiety disorders.  Study subjects received prescription for CES accompanied by psychological testing. They received a pre and post treatment psychiatric evaluation.

Pertinent measures in the psychological testing included the Wechsler Intelligence scales, IPAT (depression), and the STAI (anxiety).  CES intervention included at least one 45 minute session per day.  Many patients also received three weeks of group rational behavior therapy sessions (two to three sessions per week), Some received weekly psychotherapy. Others received no other concurrent therapy.  At the time of this writing, almost one hundred patients have received this treatment.

Results

In most cases a four week term of treatment appears to alleviate both the minor and major depressions.  Minor depressions (dysthymias) usually begin to lift in the first week of CES treatment. Patients often have “good” and “bad” days during this period. Major depressions show much amelioration between the third and fourth week.

Unfamiliar memories often rise to conscious awareness in the first and second weeks of treatment. These may include psychopathological repressions.  This provides an excellent opportunity for therapists to assist a patient in exploring “core issues”.  Rational behavior therapy and individual counseling can both assist integration of now conscious memories.  Cognitive training can offer new methods of dealing with depression, anxiety, stress, and their precipitating situations.

Patients with sleep disorders usually re-initiate a normal sleep cycle. Patients frequently describe a new sense of well being.  They report they no longer think about or dwell upon previously ruminative and bothersome issues and past experiences.  In cases where the patient used anti-depressant or anti-anxiety medication they have successfully eliminated or greatly reduced dosage within the four week period.

Cognitive function, as measured by the Wechsler scales, has shown gains.  These gains exceed the expected test-retest gains.  These gains occurred most often in the Performance area. We have yet to analyze the data for relationships between cognition and levels of depression or anxiety.

Discussion                    

CES seems an effective and safe treatment for the amelioration of mood disturbances in depressed and anxious outpatients.  The treatment and recovery from depression and anxiety related disorders seems to follow a predictable pattern of recovery.  Many patients also improved cognitive functioning.  These improvements appeared especially in Performance area tasks.

The bibliography refers to many other studies of  CES.  No cases studied to date have revealed any serious abreactions, contraindications, or side effects to CES treatment.  Clients generally experience significant improvement on psychological measures, including those of depression and anxiety, similar to those in this study.

In addition, the present study measures cognitive changes on the Wechsler scales, and continues to track many patients (up to one year as of this writing).  In the future, this study will include greater statistical analyses of data.