An Evaluation of the Psycho- physiological Concommitants of Increasing Alpha Wave Amplitude in Anxiety and Stress Disorders ISNR 21st Annual Conference 2013 Dallas, Texas L.A.Parkinson, A.J.Parkinson. BrainHealth, London

OUTLINE The Importance of Alpha Brain Waves The Brainstem involvement Sensory –Cognitive Integration Arousal What is Cranial Electrotherapy Stimulation? The Alpha-Stim The Pilot Study Summary Mediating Mechanisms Re -evaluation

The Importance of Alpha BrainWaves Hans Berger first described the Alpha Waveband in 1929 (8-11Hz, rhythmic) For many years thought to be associated with calm relaxation – even “zoned out” or idling state of the brain Parkinson (1973) used alpha-wave training to induce relaxation in patients with agoraphobia.

WHAT is ALPHA ACTIVITY? Basanova 2009 ObjectivesObjectives 1.Brain dominant oscillations frequency in posterior area 2.Amplitude suppression in response to eyes open 3.Alpha bursting spindles 1.Brain dominant oscillations frequency in posterior area 2.Amplitude suppression in response to eyes open 3.Alpha bursting spindles eyes closed - ECeyes open - EO

Psychometric characteristics associated with alpha activity indices Objectives Alpha-activity indicesCognitive dataReference Individual peak frequency (Hz) Fluency in creative thinking, mental rotation task performance Hanslmayr et al 2005; Bazanova & Aftanas, 2007 Power in upper alpha range in eyes closed resting (mkV2) Cognitive and psychomotor peak performance Hummel et al 2004; Bazanova et al 2003; Alpha amplitude suppression (log%) Attention, sport and musical peak performance Barry et al 2007, Shmelkina 2003 Individual alpha band width (Hz) Plasticity in creative thinking, efficiency in BFB training Bazanova & Aftanas, 2007 Alpha bursting segments length Academic achievements, Cognitive productivity Maltsev et al 1997; Bazanova & Aftanas, 2007 Amplitude variability intra alpha bursting segment Self actualization, self control ability Tatcher 2007 Bazanova et al, 2007

Also Sensory Motor Strip Rhythm Mountcastle(1992) found that the alpha- wave band facilitates the integration of brain activity triggered by sensory stimuli with the activation of the neural images of current or past experience

Mountcastle(1998) “Using brain oscillations has become one of the most important conceptual and analytic tools for the understanding of cognitive processes.” Gebber et al(1995)found that the alpha- wave has the best test – retest reliability of all brain waves and is an intra individual stable trait.

Basar(2011) “Alpha is one of the fundamental functional operators of the brain for signal processing and communication in the sensory-cognitive field”. Barman and Gebber(1993&2007) Alpha operating oscillations are found also in the spinal cord

The Brainstem Hernandez-Peon(1961) The brainstem reticular system is a region where all sensory modalities converge Basar(2012) The core of the brainstem may be viewed as a form of “high command” which constantly receives and controls all information from the external and internal environments.

The Alpha Rhythm Steriade et al (2001) : is generally considered an index of vigilance or arousal. Vecchiato et al (2011) :is widely used as an index of evaluation for relaxation or pleasure in neuromarketing.

Alpha Rhythm and ANS Pineda(2005) Rhythmic oscillations in alpha become coherently engaged in transforming perception into action …a 10Hz rhythm reflects the organisation of a brainstem network that governs Sympathetic Nervous System overflow. Fight Flight or Freeze. Anxiety/Fear Response

What is Cranial Electrotherapy Stimulation(CES)? It is the use of variable current (0.5Hz pulses per second) applied to the brain with the aim of inducing the cortex to produce an increase in alpha-wave activity. It also activates neurons in the brainstem.

The Alpha-Stim AID

The Alpha-Stim M For Pain

Research With Alpha-Stim Approx. over 100 research reports The Science of CES

Key Findings on the Use of the Alpha-Stim 100/M Pain That nerve pathways that project into the brain and spinal cord were activated. Including the Serotonergic (5-HT) Raphe nucleii which inhibit the cholinergic and nor-adrenergic systems Thalamo-cortical activity was suppressed reducing arousal and agitation

The Use of The Alpha-Stim 100 Alters sensory processing and induces alpha-wave activity Modulates pain perception Alters pain perception, cognitions and emotionality through the limbic fore-brain

The Study Procedure Patient population complaining of Stress or Anxiety but not on any medication or UDS DASS – Depression, Anxiety & Stress Scale (Lovibond & Lovibond 1995) Excluded if scored 14+ on Dep Subscale 16 participants (8 males, 8 females) Age Range 24 – 63 years

Baseline CNS monitoring at Cz Midline of SMS delta 1 – 4 Hz theta Hz alpha 8 – 11 Hz lo-beta 12 – 15 Hz beta Hz hi-beta Hz gamma 38 – 42 Hz

Put on one month waiting list Then Re-Assessed : CNS and DASS Provided with Alpha-Stim for 2 months Home Use – 20 minutes per day. Re – Assessed CNS and DASS

Results Mean Alpha Wave Amplitudes T1 T2 T T1 to T2 ns T2 to T3 p < 0.05

Results T1 to T2 nsT2 to T3 p < 0.05

Results: DASS Mean Scores Depression T1 T2 T (mild) (normal) (normal)

Results: DASS Mean Scores (Mild)(Normal)

Anxiety Mean Scores T1 T2 T (severe) (severe) (mild) T1 to T2 ns T2 to T3 p< 0.01

Results T1 to T2 nsT2 to T3 p < 0.01 (Severe) (Mild)

Stress Mean Scores T1 T2 T (severe) (severe) (mild) T1 to T2 ns T2 to T3 p< 0.01

Results T1 to T2 nsT2 to T3 p < 0.01 (Severe) (Mild)

Summary So Far Using CES led to a significant increase in alpha - wave activity and to a significant decrease in self – report measures of stress and anxiety. The importance of the alpha – wave in therapeutic progress should not be under estimated in view of its role in the sensory – cognitive field, the processing of unwanted images and the amelioration in levels of stress and anxiety. This was a pilot study and further research is needed. There is likely to be greater clinical applicability than is currently realised.

Mediating Mechanisms? Why Does It Work? What Is Going On?

Omata et al(2013)Department of Functional Brain Research, Tokyo Using EEGs and FMRIs with alpha rhythm The slow fluctuation component is correlated with signal changes in the brainstem, the medial thalamus and ACC The fast fluctuation component is correlated with signal changes in the lateral part of the thalamus and the ACC but NOT the brainstem

Some Other Clinical Applications Depression Insomnia Addiction Withdrawal Multiple Sclerosis As a Potentiator Pain

Methadone Self Withdrawal Study Gomez et al (1979) Brit. J. Psychiatry 28 Heroin Addicts 3 groups – CES, Sham CES, Placebo Over 10 day period CES group reduced Heroin significantly from 42mg to 12mg Sham from 42mg to 37mg Placebo Control (WL) from 42mg to 41mg

Mood, Addiction and CES USA retrospective study. 200 patients with alcohol, cocaine, heroin or prescription meds addictions in 28 day in-patient setting.

Profile of Mood States % Improvement Pre-Post State Without CES With CES Anxiety Depression Anger Lethargy 5 38 Fatigue Confusion 2 76

Fibromyalgia Lichtbroun et al (2002) Double blind study: Alpha Stim, Sham or Control Significant improvement in pre to post tender point pain ratings in CES group

La Jolla CES Open Clinical Study Tyers (2000) 28 Started study: daily 60 minute CES treatment for 3 weeks 19 completed and found improvement in:- Tender points, self rated pain, sleep, feeling of well being, quality of life. All changes significant

Tyers (2000) cont: Significant improvements in the 19 :- Anxiety, Depression, Anger, Lethargy, Fatigue, Confusion, Total Mood Disturbance

Multiple Sclerosis Pilot study Daily 60 minute CES treatment for 1 month Improvements in spasticity, vision, fatigue, pain, left hand, right hand

Multiple Sclerosis

Potentiation of Anaesthesia Stanley et al (1982) 50 subjects with urology surgery 2 Groups: Anaesthesia with CES, Anaesthesia alone CES patients needed less anaesthesia

Alpha Impact Mechanism EEG and FMRI Study found:- Positive Correlations between the Alpha Rhythm and the Central deep-lying brain regions such as the thalamus, amygdala and insula as well as the anterior cingulate cortex and cerebellum.(Sadato et al 1998)

Alpha Oscillations Related to 3 different types of cortex areas:- The generators of the cortical rhythm-the occipital cortex –ADPF Areas of the circuit but not direct generators – thalamus Those areas of the cortex linked to arousal (Salah-Haddadi et al 2003)

Summary Using CES led to a significant increase in alpha-wave activity and a significant reduction in self – report measures of anxiety and stress. The importance of the alpha-wave in therapeutic progress should not be underestimated in view of its role in the sensory- cognitive field, the processing of images the amelioration of stress, anxiety, depression, insomnia, addictions, fibro-myalgia and female neuro-endocrine dysfunction. This was a pilot study and further research is needed. There IS greater applicability than currently realised, and the mediating mechanisms are better understood.