HIRREM® is the Core Brain Technology Shared with Cereset™
Cereset Research™ is the evolution of HIRREM®, or High-resolution, Relational, Resonance-based Electroencephalic Mirroring, which is a research technology used for specific indications, including insomnia, PTSD, concussions, hot flashes, pain, etc. The same relaxation aspects of the technology are found in HIRREM and Cereset. We are the sole developer of this advanced core technology.
HIRREM is a precision-guided technology that permits the brain to perceive its own functionality in real time, supporting brain oscillation patterns to optimize in client-unique ways. Use of HIRREM is typically accompanied by improved sleep and other benefits. Physiological sleep is critical for health, performance, and global brain plasticity.
HIRREM is the first and only example of closed-loop, allostatic neurotechnology. As a healthcare intervention, closed-loop, allostatic neurotechnology is a form of precision medicine for the brain. Closed-loop strategy entails monitoring brain states in real time and returning signals to the user that do not depend on clinical evaluation or conscious learning. (In contrast, open-loop approaches do not pay attention to the brain’s changing functionality; learner-in-the-loop approaches train the individual to move brain activity toward a population average. Allostasis means “stability through change,” and it is a twenty-first century model of physiological regulation that identifies the brain as the organ of central command. (In contrast, the homeostasis idea of “stability through constancy” is based on a laboratory animal experimentation paradigm which dates to the nineteenth century.) Allostasis concords with evolutionary perspectives in biomedicine, and predicts that more optimal brain function should entail more optimal health and context-dependent performance.
Noninvasive neurotechnology from Cereset Research is being studied at the following institutions:
- Wake Forest School of Medicine, Department of Neurology, Winston-Salem, North Carolina
- Womack Army Medical Center, Fort Bragg, North Carolina.
- Uniformed Services University, Bethesda, Maryland.
Funding for this research has been provided by independent third parties including but not limited to:
- The Susanne Marcus Collins Foundation, Inc., for clinical trials to evaluate HIRREM for migraine, insomnia, and other conditions ($3 million to Wake Forest School of Medicine; 2011 – present).
- Office of the Under Secretary of Defense (Acquisition, Technology, and Logistics), to evaluate HIRREM for military personnel with traumatic stress symptoms ($107,000 to Wake Forest School of Medicine; 2014).
- United States Army Research Office, to develop Technology to Regulate Circadian Rhythm for Health and Performance, Phase I STTR Award to Brain State Technologies ($150,000; 2014).
- US Army Medical Department, Advanced Medical Technology Initiative Rapid Innovation Award to Fort Bragg, Womack Army Medical Center, to evaluate feasibility of wearable brain optimization technology in special operations personnel ($30,000 Womack Army Medical Center; 2017).
- Congressionally Directed Medical Research Programs, Psychological Health and Traumatic Brain Injury Research Program, for clinical trials to evaluate closed-loop allostatic neurotechnology for military service members with persisting symptoms after traumatic brain injury (Contract #W81XWH-17-2-0057, $2,833,185 to Brain State Technologies, with sub-awards to Geneva Foundation on behalf of Womack Army Medical Center, and Henry Jackson Foundation on behalf of Uniformed Services University).
Open-label, randomized crossover pilot trial of high-resolution, relational, resonance-based electroencephalic mirroring (HIRREM) to relieve insomnia (2011)
This open label, randomized, crossover study enrolled adults with insomnia (n=20) to be assigned either to HIRREM (8-12 sessions), or a wait-list control condition. Analysis of Insomnia Severity Index (ISI) scores showed a differential reduction of 10.3 points (95% CI: -13.7 to -6.9, p < 0.0001) in favor of the HIRREM group. There was comparable benefit for the crossed-over group after they received HIRREM, and there was durability of the ISI improvement four weeks post- HIRREM, in both groups. This study showed that HIRREM was feasible for individuals with moderate to severe insomnia, and associated with clinically relevant, statistically significant benefits, suggesting that a larger controlled trial was warranted. Results were presented as a poster at the Associated Sleep Societies Meeting in Boston, 2012, and a full manuscript was published subsequently. Research support was provided through a seed grant from Brain State Technologies.
Randomized placebo-controlled trial of high-resolution, relational, resonance-based electroencephalic mirroring (HIRREM) to reduce frequency and severity of migraine headaches (2011-12)
This single-blind, randomized, placebo-controlled study for individuals (n=30) with chronic episodic migraine assessed whether six to sixteen sessions of HIRREM in addition to usual care would reduce headache frequency and severity, compared to a sham intervention. The primary outcome was a daily headache diary over the two months following completion of HIRREM or placebo. A total of 30 participants completed the study. Before intervention, the HIRREM group tended to have a greater likelihood of headache days (42% versus 37%, p=0.064). During the post- intervention period, the HIRREM group had a 33.3% reduction in the likelihood of experiencing headache compared to their baseline, compared to a 13.5% reduction for those in the placebo group (p=0.052). The safety and positive effects to 8 weeks post-intervention suggested that larger controlled trials are warranted. Results were presented as a poster at the International Headache Conference, Boston MA, June 2013. Research support was provided by a grant from the Susanne Marcus Collins Foundation, Inc.
High-resolution, relational, resonance-based, electroencephalic mirroring (HIRREM) to relieve insomnia: a randomized, placebo-controlled clinical trial (2013-17)
This randomized, placebo-controlled study was designed to determine whether, in adults with insomnia, the addition of HIRREM sessions to usual care would reduce insomnia symptoms at two months following completion of their sessions, more than placebo. 107 adults with insomnia were randomly assigned to either HIRREM (10 sessions, n=56) or a sham intervention (10 sessions, n=51). At the two-month follow-up visit, those randomized to HIRREM had a greater reduction in their ISI score (-2.1, SE 1.1, p=0.046) than those in the placebo group. Furthermore those assigned to HIRREM showed multiple improvements in autonomic cardiovascular regulation as measured by indices of heart rate variability and baroreflex sensitivity, whereas those assigned to placebo did not, suggesting that HIRREM can improve functionality of the brain-heart axis. Results are being presented at the Associated Sleep Societies Meeting, Boston MA, June 2017. The data are also being prepared for submission to the US FDA, as clinical performance evidence that supports approval of HIRREM as a De Novo medical device indicated to treat insomnia. Research support was provided by the Susanne Marcus Collins Foundation, Inc.
Randomized controlled trials of closed-loop allostatic neurotechnology to improve sensory function and pain management after traumatic brain injury (2017-21)
Funding Agency: Congressionally-Directed Medical Research Program (CDMRP), Psychological Health/Traumatic Brain Injury Program
Principal Investigator: Lee Gerdes, Cereset/Brain State Technologies
Collaborators: Ret. Col. Michael Roy, M.D., Uniformed Services University of Health Sciences, Bethesda, Maryland; Wesley Cole, Ph.D., Defense and Veterans’ Brain Injury Center, Womack Army Medical Center, Fort Bragg, North Carolina.
Performance period: 30 September 2017, through 29 September 2021
Total funding: $2,833,185
Award portion to Brain State: $757,236
Objective and Significance of the Research: Conduct two separate clinical trials, to evaluate HIRREM and Braintellect-2 as treatment for pain and sensory disturbance associated with traumatic brain injury. Data from the first trial (placebo-controlled study of HIRREM, 10 sessions, 2017-2019) may lead to an FDA approval of HIRREM as treatment for pain and sensory disturbance related to traumatic brain injury.
Randomized controlled studies of HIRREM for mitigation of symptoms of posttraumatic stress disorder, and traumatic brain injury (In planning, to begin in 2018)
Separate studies are in planning to evaluate HIRREM as treatment for posttraumatic stress disorder (PTSD) and traumatic brain injury. Outcomes will include self-reported symptom scores, measures of autonomic cardiovascular regulation, and others. Research support is being provided by the Susanne Marcus Collins Foundation, Inc.
Abstracts and Presentations
IRB Approved Clinical Trials
Clinical Trial Participants
Peer-reviewed Scientific Publications Related to HIRREM
Lee SW, Laurienti PJ, Burdette JH, Tegeler CL, Morgan AR, Simpson SL, Gerdes L, Tegeler CH (2018). Functional Brain Network Changes Following Use of an Allostatic, Closed‐Loop, Acoustic Stimulation Neurotechnology for Military‐Related Traumatic Stress. J. Neuroimaging. 00:1-9. doi: 10.1111/jon.12571. Epub 2018 Oct 10. https://onlinelibrary.wiley.com/doi/full/10.1111/jon.12571
Shaltout HA, Lee SW, Tegeler CL, Hirsch JR, Simpson SL, Gerdes L, and Tegeler CH. (2018). Improvements in Heart Rate Variability, Baroreflex Sensitivity, and Sleep After Use of Closed-Loop Allostatic Neurotechnology by a Heterogeneous Cohort. Front. Public Health. 10:3389. https://doi.org/10.3389/fpubh.2018.00116
Tegeler CL, Gerdes L, Shaltout HA, Cook JF, Simpson SL, Lee SW and Tegeler CH. (2017). Successful use of closed-loop allostatic neurotechnology for post-traumatic stress symptoms in military personnel: self- reported and autonomic improvements. Military Medical Research. Published: 22 December 2017. https://doi.org/10.1186/s40779-017-0147-0
Tegeler CH, Cook JF, Tegeler CL, Hirsch JR, Shaltout HA, Simpson SL, Fidali B, Gerdes L, and Lee SW. (2017). Clinical, hemispheric, and autonomic changes associated with use of closed-loop, allostatic neurotechnology by a case series of individuals with self-reported symptoms of post-traumatic stress. BMC Psychiatry. https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-017-1299-x
Tegeler CH, Tegeler CL, Cook JF, Lee SW, Gerdes L, Shaltout HA, Miles CM, and Simpson SL. (2016). A preliminary study of the effectiveness of an allostatic, closed-loop, acoustic stimulation neurotechnology in the treatment of athletes with persisting post-concussion symptoms. Sports Medicine – Open. Published online 14 September. http://link.springer.com/article/10.1186/s40798-016-0063-y
Fortunato JE, Tegeler CL, Gerdes L, Lee SW, Pajewski NM, Franco ME, Cook JF, Shaltout HA, Tegeler CH. (2016). Use of an allostatic neurotechnology by adolescents with postural orthostatic tachycardia syndrome is associated with improvements in heart rate variability and changes in temporal lobe electrical activity. Experimental Brain Research. 234(3): 791-8. http://link.springer.com/article/10.1007%2Fs00221-015-4499-y
Gerdes L., Tegeler CH, and Lee SW. (2015). A groundwork for allostatic neuro-education. Front. Psychol. 6:1224. http://journal.frontiersin.org/article/10.3389/fpsyg.2015.01224/full
Tegeler CH, Shaltout HA, Tegeler CL, Gerdes L, and Lee SW. (2015). Rightward dominance in temporal high-frequency electrical asymmetry corresponds to higher resting heart rate and lower baroreflex sensitivity in a heterogeneous population. Brain Behav. 5(6): e00343. http://onlinelibrary.wiley.com/doi/10.1002/brb3.343/abstract;jsessionid=94546EC14CF847CAE9827B0B 21652B58.f02t01
Tegeler CH, Tegeler CL, Cook JF, Lee SW, and Pajewski NM. (2015). Reduction in menopause-related symptoms associated with use of a noninvasive neurotechnology for autocalibration of neural oscillations. Menopause. 22(6): 650-5.
Lee SW, Gerdes L, Tegeler CL, Shaltout HA, and Tegeler CH. (2014). A bihemispheric autonomic model for traumatic stress effects on health and behavior. Front. Psychol. 5:843. http://journal.frontiersin.org/article/10.3389/fpsyg.2014.00843/full
Gerdes L, Gerdes P, Lee SW, and Tegeler CH. (2013). HIRREM: a non-invasive, allostatic methodology for relaxation and auto-calibration of neural oscillations. Brain Behav. Mar; 3(2): 193-205. http://onlinelibrary.wiley.com/doi/10.1002/brb3.116/abstract
Tegeler CH, Kumar S, Conklin D, Lee SW, Gerdes EL, Turner DP, Tegeler CL, Fidali B, and Houle TT. (2012). Open label, randomized, crossover pilot trial of high resolution, relational, resonance-based, electroencephalic mirroring (HIRREM) to relieve insomnia. Brain Behav. Nov; 2(6): 814-24. http://onlinelibrary.wiley.com/doi/10.1002/brb3.101/abstract
Manuscripts Under Review or in Preparation
Laurienti P, Burdette J, Tegeler CL, Morgan A, Simpson S, Gerdes L, Tegeler, CH. (2018). Functional brain network changes following the use of an allostatic, closed-loop, acoustic stimulation neurotechnology for symptoms of military-related traumatic stress. Functional MRI (fMRI). Journal of Neuroimaging.
Tegeler CH, Lee SW, and Shaltout H. (2014). Significance of right anterior insula activity for mental health intervention. JAMA Psychiatry. 71(3): 336.
Abstracts and Presentations
Shaltout HA, Tegeler CL, Tegeler CH. Use of a noninvasive, closed-loop, allostatic, neurotechnology reduced blood pressure and improved heart rate variability in a pre-hypertensive cohort. Poster presentation at the American Heart Association, Council on Hypertension, San Francisco CA, September 16, 2017.
Shaltout HA, Tegeler CL, Tegeler CH. Improved heart rate variability and symptoms of insomnia and stress, with use of a closed-loop allostatic neurotechnology in law enforcement officers. Poster presentation at the American Heart Association, Council on Hypertension, San Francisco CA, September 16, 2017.
Shaltout HA, Tegeler CL, Tegeler CH. Healing a broken heart using a closed-loop, allostatic neurotechnology: a case study in a patient suffering from Takotsubo Syndrome. Poster presentation at the American Heart Association, Council on Hypertension, San Francisco CA, September 16, 2017.
Tegeler CL, Howard LJ, Schmidt KD, Cook JF, Kumar S, Simpson SL, Lee SW, Gerdes L, Tegeler CH. Use of a Closed-Loop Acoustic Stimulation Neurotechnology Improves Symptoms of Moderate to Severe Insomnia: Results of a Placebo-Controlled Trial. Abstract 0389. Accepted for poster presentation at SLEEP 2017, Boston, MA, June 3-7, 2017.
Shaltout HA, Tegeler CL, Lee SW, Tegeler CH. In Subjects with Insomnia, Use of a Closed-Loop Acoustic Stimulation Neurotechnology Improves Heart Rate Variability and Baroreflex Sensitivity: Results of a Placebo-Controlled Clinical Trial. Abstract 0363. Accepted for poster presentation at SLEEP 2017, Boston, MA, June 3-7, 2017.
Nahman J, Dagenbach D, Lyday RG, Laurienti PM, Tegeler CH. Basal ganglia changes in functional connectivity and changes in anxiety. Poster presented at the annual meeting of the North Carolina Cognition Conference, UNC-Greensboro, Greensboro, NC, March 25, 2017.
Shaltout HA, Tegeler CL, Tegeler CH. Reduction of Blood Pressure and Improvement of Heart Rate Variability in Hypertensive Cohort Associated With Use of a Closed Loop Neurotechnology. P310. Accepted for poster presentation at the Hypertension 2016 Scientific Sessions, Orlando, FL, September 14-17, 2016.
Tegeler CL, Shaltout HA, Howard LJ, Tegeler CH. Improved Autonomic Cardiovascular Regulation and Reduced Symptoms Associated with Use of Closed-loop Noninvasive Neurotechnology by Healthcare Workers. P627. Accepted for poster presentation at the Hypertension 2016 Scientific Sessions, Orlando, FL, September 14-17, 2016.
Shaltout HA, Tegeler CL, Tegeler CH. Improvement of Autonomic Function and C-Reactive Protein in Military Personnel with Traumatic Stress After Use Of a Closed Loop Neurotechnology. P625. Accepted for poster presentation at the Hypertension 2016 Scientific Sessions, Orlando, FL, September 14-17, 2016.
Tegeler CL, Shaltout HA, Tegeler CH. Reduced Symptoms And Improved Heart Rate Variability Associated With Use Of Closed-Loop Noninvasive Neurotechnology By Migraineurs. P602. Accepted for poster presentation at the Hypertension 2016 Scientific Sessions, Orlando, FL, September 14-17, 2016.
Tegeler CH, Tegeler CL, Shaltout HA, Cook JF, Simpson SL. Improved symptoms, autonomic cardiovascular regulation, and function after use of a closed-loop neurotechnology for symptoms of military-related traumatic stress. Accepted for oral presentation at the 2016 Military Health System Research Symposium, Orlando/Kissimmee, FL, August 15-18, 2016.
Tegeler CH, Tegeler CL, Morgan AR, Burdette JH, Laurienti PJ. Military personnel with traumatic stress show changes in large-scale brain networks and global perfusion after use of a closed-loop neurotechnology. Accepted for poster presentation at the 2016 Military Health System Research Symposium, Orlando/Kissimmee, FL, August 15-18, 2016.
Tegeler CL, Howard LJ, Hirsch JR, Shaltout HA, Lee SW, Tegeler CH. Durability of symptom reduction and improved autonomic cardiovascular regulation after use of closed-loop neurotechnology by athletes with persisting post-concussion symptoms. Accepted for poster presentation at The Sports Concussion Conference, Chicago, IL, July 8-10, 2016.
Tegeler CH, Tegeler CL, Cook JF, Lee SW, Shaltout HA, Laurienti PJ. Military personnel with traumatic stress show changes in large-scale brain networks after use of a closed-loop neurotechnology. Neurol. 86(S16): I7.009. Accepted for dual presentation at the American Academy of Neurology Meeting, Vancouver, BC, Canada, April 15-21, 2016.
Tegeler CH, Tegeler CL, Cook JF, Howard L, Lee S, Shaltout HA. Durability of symptom reductions associated with use of HIRREM by military personnel with traumatic stress. Neurol. 86(S16): I8.007. Data Blitz Presentations: Emerging Technologies for Neurological Research and Care, and Behavioral and Cognitive Neurology: Assessment Tools. Accepted for dual presentation at the American Academy of Neurology Meeting, Vancouver, BC, Canada, April 15-21, 2016.
Tegeler CL, Shaltout HA, Lee SW, Tegeler CH. Military personnel with traumatic stress demonstrate improved autonomic cardiovascular regulation after use of a closed loop neurotechnology. Neurol. 86(S16): P5.122. Accepted for presentation at the American Academy of Neurology Meeting, Vancouver, BC, Canada, April 15-21, 2016.
Tegeler CH et al. (2016). Military personnel with traumatic stress show changes in large-scale brain networks after use of a closed-loop neurotechnology. Accepted for American Academy of Neurology 68th Annual Meeting, Vancouver BC, Canada, Presentations: The Human Connectome: Implications for Clinical Neurology Poster Presentations, and Behavioral and Cognitive Neurology: Markers of Cognition, April 18-19, 2016.
Tegeler CH, Laurienti PJ, Tegeler CL, Shaltout HA, and Cook JF. (2015). Military personnel with traumatic stress show improved symptoms and HRV after a closed-loop neurotechnology. Accepted for Poster Presentation at AMSUS, the Society of Federal Health Professionals, San Antonio TX, December 1-4, 2015.
Tegeler CH, Laurienti PJ, Tegeler CL, Cook JF, Wistermayer PR, Lee SW, and Shaltout HA (2015). Military personnel with traumatic stress demonstrate changes in the default mode network after use of a closed-loop neurotechnology. Accepted for Poster Presentation at the American Neurological Association 2015 Annual Meeting, Chicago, September 27-29, 2015.
Tegeler CH. (2014). Use of a noninvasive neurotechnology for vasomotor symptoms. Invited lecture to the North American Menopause Society Translational Science Symposium, Washington DC, October 14, 2014.
Tegeler CH, Tegeler CL, Cook JF, Lee SW, and Shaltout HA. (2014). Use of a closed-loop neurotechnology, HIRREM, is associated with symptom reduction and improved autonomic regulation in migraineurs. Data blitz and poster presentation at the American Neurological Association Annual Meeting, Baltimore, October 12-13, 2014.
Tegeler CH, Tegeler CL, Cook JF, Lee SW, Gerdes L, Shaltout HA, and Miles CM. (2014). Use of HIRREM is associated with improved symptoms and neural oscillatory balance in athletes with post-concussion symptoms. Poster presentation at the American Academy of Neurology Sports Concussion Conference, Chicago IL, July 11-13, 2014.
Tegeler CH, Tegeler CL, Cook JF, Lee SW, Franco ME, Nicholas JN, Ray CE, Howard LJ, and Shaltout HA. (2014). A noninvasive approach to improve insomnia in a military cohort. Poster presentation at the Annual Meeting of the Associated Professional Sleep Societies, Minneapolis MN, May 31 – June 4, 2014.
Tegeler CH, Tegeler CL, Cook J,F, Lee SW, Franco ME, Gerdes L, and Shaltout HA. (2014). Use of a non-invasive neurotechnology, HIRREM, is associated with improved sleep, mood, and baroreflex sensitivity in athletes with persisting post-concussion symptoms. Poster presentation at the American Academy of Neurology Annual Meeting, Philadelphia, April 26 – May 3, 2014.
Cook J, Tegeler CL, Lee SW, Shaltout HA, Franco M, and Tegeler CH. (2014). Use of a non-invasive neurotechnology, HIRREM, is associated with improved sleep and mood in a heterogeneous cohort. Poster presentation at the American Academy of Neurology Annual Meeting, Philadelphia, April 26 – May 3, 2014.
Tegeler CL, Fortunato J, Cook J, Lee SW, Franco M, and Tegeler CH. (2014). A noninvasive neurotechnology, HIRREM, is associated with symptom reduction and improved cardiovascular autonomic measures in adolescents with POTS. Poster presentation at the American Academy of Neurology Annual Meeting, Philadelphia, April 26 – May 3, 2014.
Miles CM, Tegeler CL, Lee SW, Franco ME, and Tegeler CH. (2014). A case (series) of improved symmetry. Poster presentation at the American Medical Society for Sports Medicine Annual Meeting, New Orleans, April 7, 2014.
Tegeler CH, Tegeler CL, Cook JF, Lee SW, Franco ME, Gerdes L, and Shaltout HA. (2014). Use of HIRREM, a noninvasive neurotechnology, is associated with symptom reduction and increased heart rate variability among individuals with traumatic brain injury. Podium presentation at the International Brain Injury Association, Tenth World Congress on Brain Injury, San Francisco, March 19-22, 2014.
Fortunato JE, Tegeler CL, Lee SW, Pajewski NM, Franco M, Cook JF, and Tegeler CH. (2013). Case series using high-resolution, relational, resonance-based electroencephalic mirroring (HIRREM) for POTS. Clin Auton Res. 23(5):269-70. Poster presentation at the American Autonomic Society Annual Meeting, Hawaii, October 23-26, 2013.
Tegeler CH, Tegeler CL, Lee SW, and Cook JF. (2013). High-resolution, relational, resonance-based electroencephalic mirroring (HIRREM) reduces symptoms and EEG asymmetry in an individual with PTSD. Annals of Neurology. 74(S17): S77. Poster presentation at the American Neurological Association Annual Meeting, New Orleans, October 12-15, 2013.
Tegeler CH, Tegeler CL, Lee SW, Shaltout HA, and Pajewski NM. (2013). Neural-oscillatory intervention for auto-calibration improves EEG asymmetry and heart rate variability (HRV). Annals of Neurology. 74(S17): S77. Poster presentation at the American Neurological Association Annual Meeting, New Orleans, October 12-15, 2013.
Tegeler CL, Cook JF, Lee SW, Pajewski N, Nicholas J, and Tegeler CH. (2013). Pilot study of menopause-related symptom reduction through a noninvasive EEG-based technology for auto-calibration of neural oscillations (HIRREM). Menopause. (20)12: 1356. Poster presentation at the North American Menopause Society Annual Meeting, Dallas, October 9-12, 2013.
Tegeler CH, Tegeler CL, Kumar SR, Turner DP, Gerdes L, Lee SW, and Houle TT. (2013). Randomized, placebo-controlled pilot trial of a novel, noninvasive electroencephalic feedback-based intervention, HIRREM, for alleviation of episodic migraine. Cephalalgia: Abstracts of the 2013 International Headache Conference. June; 33(8) Supplement: 99-100. Poster presentation at the International Headache Congress, Boston, June 27-30, 2013.
Tegeler CH, Lee SW, Tegeler CL, and Shaltout HA. (2013). Correlation between temporal lobe EEG asymmetry and heart rate variability. Neurology. Feb 12, 2013; 80 (Meeting abstracts 1): P03:031. Poster presentation at American Academy of Neurology Annual Meeting, San Diego, March 16-23, 2013.
Tegeler CH, Fidali B, Lee SW, Tegeler CL, and Gerdes L. (2012). Case series of PTSD symptom reduction through a new, non-invasive, EEG-based technology for facilitating self-regulation of neural oscillations (HIRREM). Poster presentation at 28th Annual Meeting of International Society for Traumatic Stress Studies, Los Angeles, Nov 1-3, 2012.
Tegeler CH, Kumar S, Conklin D, Turner D, Tegeler CL, McCall V, and Houle T. (2012). A New Method of Dynamic, Relational, Electroencephalic Auditory Feedback for Primary Insomnia. Sleep. 35, Abstract Supplement: A220. Poster presentation at the Associated Professional Sleep Societies Annual Meeting, Boston, June 9-13, 2012.
Grand Rounds and Other Invited Presentations Given by Prof. Charles Tegeler, Related to HIRREM
Reducing Insomnia and Effects of Traumatic Stress: The HIRREM Research Program. WFSM Medical Alumni Association dinner event, The Dewberry, Charleston, SC, June 22, 2017.
Closed-loop Acoustic Stimulation to Reduce Insomnia and Effects of Traumatic Stress: The WFSM HIRREM Research Program. WFSM Medical Alumni Association’s Board of Directors meeting, One Biotech Place, Winston-Salem, NC, May 13, 2017.
Closed-loop Acoustic Stimulation to Reduce Insomnia and Effects of Traumatic Stress: The WFSM HIRREM Research Program. Briefing for site visit by 8 faculty from the University of Virginia School of Medicine Contemplative Sciences Center, WFSM, Winston-Salem, NC, March 24, 2017.
Closed-loop Acoustic Stimulation to Reduce Insomnia and Effects of Traumatic Stress: The WFSM HIRREM Research Program. Briefing for Sheriff Bill Schatzman, Forsyth County Sheriff’s Office, and 10 of his leadership team, Winston-Salem, NC, March 17, 2017.
Closed-loop Acoustic Stimulation to Reduce Insomnia and Effects of Traumatic Stress: The WFSM HIRREM Research Program. Briefing for Chief Barry Rountree, Winston-Salem Police Department, and 15 members of his leadership team, Winston-Salem, NC, March 9, 2017.
Closed-loop Acoustic Stimulation for Auto-calibration of Oscillating Neural Circuits: The WFSM HIRREM Research Program. Briefing/Site Visit by Semper Fi and NICOE, WFSM, February 17th, 2017.
Closed-loop Acoustic Stimulation for Auto-calibration of Oscillating Neural Circuits: The WFSM HIRREM Research Program. Neurology Grand Rounds, UT-Memphis, Memphis, TN, January 27, 2017.
HIRREM Research at WFSM: Overview of Method, Results, and Opportunities. Office of Development and Alumni Affairs, WFSM, November 11, 2016.
HIRREM Research at Wake Forest School of Medicine (WFSM): Overview and Focus on Military Traumatic Stress, Briefing for Site Visitors from Womack Army Medical Center, and USASOC, at Fort Bragg, NC, August 24, 2016.
Closed-loop Acoustic Stimulation for Auto-calibration of Oscillating Neural Circuits: Overview and Focus on Military Traumatic Stress, Neurology Grand Rounds, University of Texas Health Science Center-San Antonio, San Antonio, TX, July 29, 2016.
Durability of Symptom Reductions Associated with Use of HIRREM by Military Personnel with Traumatic Stress. Medical, Biomedical, & Biodefense: Support to the Warfighter Symposium, Raleigh, NC, June 8, 2016.
HIRREM: Overview and Focus on Military Traumatic Stress, Palliative Care Symposium, Body, Mind, & Spirit, Spartanburg Regional Healthcare System, Spartanburg, SC, May 13, 2016.
HIRREM Research at WFSM: Focus on PTSD and Military Traumatic Stress, Sci-Works After Dark, Sci- Works, Winston-Salem, NC, February 23, 2016.
HIRREM Research at WFSM: Focus on Military Traumatic Stress, Department of Family and Community Medicine, Resident Lecture Series, Winston-Salem, NC, February 10, 2016.
HIRREM Research at WFSM: Focus on Military Traumatic Stress, Department of Psychiatry Grand Rounds, Winston-Salem, NC, November 6, 2015.
Balancing the Brain by Feedback with Auditory Tones, Sci-Works Science Café, Clemmons, NC, October 27, 2015.
Overview of HIRREM and Research Program at WFSM, Neuroscience Graduate Students lecture series, Winston-Salem, NC, October 27, 2015.
HIRREM Research Overview, for Hypertension and Vascular Research Center retreat, Winston-Salem, NC, June 22, 2015.
ANS Brain Balance & Dominance: Stress, Depression, & Sleep, for an IGNITE Conference on Autonomic Nervous System and Aging, Sticht Center on Aging, Winston-Salem, NC, March 16, 2015.
Overview of HIRREM and Research Program at WFSM, for Grand Rounds, Center for Health and Healing, Spartanburg Regional Healthcare System, Spartanburg, SC, January 21, 2015.
Noninvasive Neurotechnology (HIRREM) for Vasomotor Symptoms, for The Science of Thermoregulation and Vasomotor Symptoms: New Targets for Research and Treatment, The 2nd Utian Translational Symposium, Washington, DC, October 14, 2014.
Case Series of HIRREM for Mild TBI, for North Carolina Military Business Center Conference, Raleigh, NC, June 5, 2014.
HIRREM at Wake Forest School of Medicine: Overview and Research Update, for Grand Rounds in the Hypertension and Vascular Research Center at Wake Forest School of Medicine, February 26, 2014.
HIRREM at WFSM: Overview and Potential Military Relevance, for a NC Military Foundation/Marines Special Operations Command briefing, Raleigh, NC, February 24, 2014.
Balance and Neural Oscillations. Key Note Presentation, Healing Without Borders Annual Meeting, Denver, CO, October 5, 2013.
Traumatic Brain Injury/Concussion: A Clinician’s Perspective. MS1 Neuroscience Block, WFSM, April 2, 2013.
HIRREM at WFSM: Update on Clinical Research Outcomes. Office of Women in Medicine and Science Seminar Series, Wake Forest Baptist Health (WFBH), March 6, 2013.
HIRREM at WFSM: Overview and initial Clinical Research. Wake Forest University (WFU) Sports Medicine Staff Conference, WFU, December 4, 2012.
HIRREM at WFSM: Overview and Recent Military Experience. North Carolina (NC) Military Foundation Board of Directors, Chapel Hill, NC, December 3, 2012.
HIRREM at WFSM: Overview and Initial Experience. WFBH Department of Psychiatry Grand Rounds, WFBH, November 16, 2012.
HIRREM at WFSM: Overview for US SOCOM. Special Operations Command, McDill, AFB, October 30, 2012.
HIRREM at WFBH: Overview and Initial Clinical Research. Neuroscience Postgraduate Program Tutorial, WFBH, October 5, 2012.
HIRREM at WFBH: Overview and Initial Clinical Research. Sports Medicine Section meeting, WFBH, September 19, 2012.
HIRREM at WFBH: Program Development and Initial Clinical Research. Kansas University Medical Center, TBI Research Working Group, web presentation, August 30, 2012.
HIRREM at WFBH: Overview and Initial Clinical Research. Center for Integrative Medicine, Spartanburg Regional Medical Center, Spartanburg, SC, August 23, 2012.
BioBiz Partnering Forum, Winston-Salem, NC, June 28, 2012.
HIRREM for Insomnia: Results of a Pilot Clinical Trial. Grand Rounds for Hispanics in Research Capability, University of Puerto Rico, School of Health Professions, San Juan, PR, May 21-22, 2012.
HIRREM for Migraine: Overview and Initial Results of a Pilot Clinical Trial. Action Health, Winston- Salem, NC, March 26, 2012.
HIRREM for Insomnia: Results of a Pilot Clinical Trial. Sticht Center Conference on Aging, WFBH, February 8, 2012.
CIM Update: High-resolution, Relational, Resonance-based, Electroenchephalic Mirroring (HIRREM). CIM Steering Committee Meeting, WFSM, December 12, 2011.
Brainwave Optimization for Insomnia: Results of a Pilot Clinical Trial. Neurology Grand Rounds, WFSM, November 1, 2011.
Other Selected Presentations by Brain State Technologies
Advancing Concussion Management through Innovative Technology. Sung Lee, Discussant. Annual Assembly of the American Academy of Physical Medicine and Rehabilitation, Denver, Colorado, October 14, 2017.
Sleep Quality and Risk for Subsequent PTSD: Implications for a Realistic Primary Prevention Strategy. Sung Lee. Presentation for Annual Meeting of the Society for Brain Mapping and Therapeutics, Los Angeles, California, April 19, 2017.
Moving the Needle on “Brain Enhancement”: Remediation of PTSD and TBI Symptomatology After Use of a Noninvasive Closed-Loop Neurotechnology. Sung Lee. Presentation for Annual Meeting of the Society for Brain Mapping and Therapeutics, Miami, Florida, April 9, 2016.
The Brain Creates. Lee Gerdes and Sung Lee, Presentation for W.O.N.D.E.R. Project Lecture Series, Foundation for Living Medicine, Arizona Science Center, Phoenix, Arizona, September 11, 2015.
The Brain as the Organ of Central Command: Implications for Health Strategies. Sung Lee and Charles Tegeler, Grand Rounds Presentation at Gibbs Cancer Center, Spartanburg Regional Healthcare System, Spartanburg, South Carolina, January 20, 2015.
Introduction to Brainwave Optimization. Lee Gerdes and Sung Lee, Presentation to introduce Community Mental Health Demonstration Project led by Ujima Enterprises, Kalamazoo, Michigan, July 25, 2011.
Can Brain-Balancing Technology Reduce Recidivism? Lee Gerdes and Sung Lee, Special Presentation to Idaho Criminal Justice Commission, Boise, ID, May 21, 2010.
The HIRREM History of Cereset Research
Cereset Research™ is the culmination of over 18 years of scientific study by Lee Gerdes, Founder & CEO and his team at Cereset™, BRAINtellect® and Brain State Technologies®. It is the evolution of HIRREM®, which is an acronym for High-Resolution Relational Resonance-based Electroencephalic Mirroring,
HIRREM uses software algorithms to translate the brain’s electrical frequencies into audible tones of variable pitch and timing. These “brain sounds” are mirrored to the user in real time via ear buds, permitting the brain to continuously update itself with respect to its own activity patterns, resulting in auto-calibration or self-optimization, typically with shifts towards improved balance, and reduced hyperarousal.
In more scientific terms, HIRREM is a non-invasive, closed-loop neurotechnology which utilizes two-channel recordings to measure the brain’s neural oscillations at high spectral resolutions, then applies intensive software algorithmic analysis to identify dominant but changing frequencies in a floating middle range. The output of the algorithms is a series of audible tones of variable pitch and timing, which are returned to the client in real time (as quickly as 4ms) through peripheral auditory neural pathways. This acoustic stimulation permits resonance between the neural oscillatory frequencies and auditory tones, which appears to facilitate a state of deep relaxation and auto-calibration of neural oscillations. It requires no direct, energetic, or invasive input to the brain, no cognitive guidance or education from a clinician, nor any referencing against population norms for the EEG.
HIRREM’s acoustic mirroring appears to facilitate a state of deep relaxation and auto-calibration of neural oscillations. Greater hemispheric symmetry and a more optimized proportionation of neural oscillations appear to be a common indirect consequence of undergoing HIRREM.
Use of the technology is typically accompanied by improved sleep, which may support greater capacity for fluid and adaptive connectivity across neural networks (Krueger et al., 1993).
Studies are currently ongoing to further investigate potential applications of Cereset Research and elucidate biophysical mechanisms of action.
Allostasis considers change to be the normative character of life and infers that the role of the brain is to optimize activity patterns both for itself (brain self-optimization) and distributed body organs (body self-optimization) that are all under the brain’s influence. Because of stress-induced allostatic load and neuroplasticity it is possible – indeed common – for the brain’s allostatic capacity for self-optimization to be compromised. We model that being “stuck” in sympathetic hyperarousal, parasympathetic immobilization, and/or admixtures of are two major (and common) modes of miscalibration. This implies a need to support the brain in its role as “master optimizer.”
Brainwave Optimization (described technically as HIRREM) is a non-invasive, closed-loop neurotechnology which utilizes two-channel recordings to measure the brain’s neural oscillations at high spectral resolutions, then applies intensive software algorithmic analysis to identify dominant but changing frequencies in a floating middle range. The output of the algorithms is a series of audible tones of variable pitch and timing, which are returned to the client in near real time (as quickly as 4ms) through peripheral auditory neural pathways. This acoustic stimulation permits resonance between the neural oscillatory frequencies and auditory tones, which appears to facilitate a state of deep relaxation and auto-calibration of neural oscillations. It requires no direct, energetic, or invasive input to the brain, no cognitive guidance or education from a clinician, nor any referencing against population norms for the EEG.
Brainwave Optimization’s acoustic mirroring appears to facilitate a state of deep relaxation and auto-calibration of neural oscillations. Greater hemispheric symmetry and a more optimized proportionation of neural oscillations appear to be common indirect consequences of undergoing Brainwave Optimization.
Studies are currently ongoing to further investigate potential applications of Brainwave Optimization and elucidate biophysical mechanisms of action – please see next page for details.
The HIRREM Process
Every brain is unique, with its own pattern of electrical frequencies (Hertz) and amplitudes (microvolts) for most efficient functioning. In the HIRREM approach, trauma, both physical and non-physical, may lead to disturbances in brain activity, including imbalances of frequencies and amplitudes. Specifically, traumas or threats can lead to activation of autonomic nervous system responses, sympathetic (fight or flight) or parasympathetic (freeze or withdrawal), to help survive the event. If the brain circuitry involved with managing the autonomic response remains chronically activated, the persisting physiological changes are not healthy and might contribute to symptoms or illnesses. The premise of HIRREM is that improved balance may be associated with reduced symptoms.
High-resolution, relational, resonance-based, electroencephalic mirroring (HIRREM®), developed and owned by Lee Gerdes and Brain State Technologies, LLC, is a noninvasive, brain feedback technology to facilitate relaxation, auto-calibration, and self-optimization of neural oscillations by using auditory tones to reflect brain frequencies in near real time (Gerdes L, et al., Brain Behav, 2013). The first step in the HIRREM process is to obtain an assessment of the brain electrical pattern. An assessment is done by making very brief recordings of the brainwaves at six or more locations on the scalp, with the recipient at rest and while carrying out a task. The assessment includes one minute recordings at each location with the eyes closed, partially open, and open while performing a specific mental task (i.e. recalling numbers, reading a passage, etc.). This provides a map of frequencies and amplitudes with the brain at rest, and under load, while interacting with the environment, allowing identification of imbalances.
Based on the initial assessment, specific protocols are chosen for the first HIRREM session. Protocols are 6-40 minute periods of auditory feedback based on observation of specific locations and frequency bands. Protocols may be run with eyes open or eyes closed. A series of protocols (3-10) comprises a HIRREM session (usually about 90-120 minutes). Following the initial session, protocols for subsequent sessions are chosen based on data from the preceding session. Thus, there is not a standardized list of protocols for a course of HIRREM sessions. The series of protocols across sessions is unique for each recipient.
HIRREM protocols are done with the recipient sitting or reclining in a comfortable chair. Sensors are placed on the scalp at specific locations, depending on the protocol, allowing the computer to observe the brainwaves, and to identify a dominant frequency at a particular moment. This frequency is assigned an auditory tone, which is played back via ear buds in nearly real time (as little as 8 milliseconds). The brainwaves are constantly changing, so the recipient hears a series of tones. It appears that the brain quickly recognizes that the tones reflect what is going on in the brain at the time. By giving the brain a chance to listen to itself via this acoustic stimulation, it will, on its own, tend to self-optimize, usually resulting in electrical shifts towards improved balance and quieting. There is no cognitive activity required by the recipient, no operant conditioning, no learner in the loop, no requirement to re-live a traumatic event, and no attempt to force the brain into a specific pattern.
Some protocols are done with eyes open, and others with eyes closed. During eyes open protocols the recipient can do some relaxing activity such as reading a book, or working a word search, while during eyes closed protocols, recipients just relax, and may even fall asleep. The various protocols are each designed to address different locations and frequencies. Although the number of sessions varies, most individuals receive at least 10 sessions. Ideally this would all occur over one week (two sessions per day), but for our research projects, the goal is to complete sessions within 2-3 weeks. The HIRREM Process is summarized in Figure 1 below (click on the figure to enlarge).
A course of HIRREM sessions is a process, not an event. Integration of changes may continue to occur for several weeks after completion of HIRREM, and, in our research experience, additional changes may be noticed for up to 4-6 weeks after the last HIRREM session. Because they might interfere with the HIRREM process, or negate changes made during a course of HIRREM sessions, alcohol, and other recreational drugs are to be avoided during and for at least 3 weeks after completion of HIRREM sessions. HIRREM is not a medical device and is not intended to treat, cure, heal, or diagnose any disease, mental illness or symptom, and individual results and duration of effects may vary.
Stress and Allostasis
Stressful situations commonly trigger finely orchestrated biological responses from the hypothalamus-pituitary-adrenal axis and the autonomic nervous system. While the circulation of stress hormones cortisol, epinephrine, and norepinephrine may be helpful in the setting of an acute stressor, their extended presence (weeks, months, or years) may cause damage to the tissues they would otherwise protect.
Neuroplasticity is often beneficial, and the brain can rewire itself according to the demands of new skills and situations. However, this also means that the brain is vulnerable to accumulating stress responses getting stuck in ultimately maladaptive patterns. Ideally, neural activities of the present should meet the needs of the present; they should not be organized to meet the demands of the past.
As defined by Sterling (2004), allostasis refers to stability (stasis) through change (allo). When well-functioning, the brain anticipates changing needs in a constantly changing environment and recalibrates system set points in accordance with present or anticipated demands. The brain dynamically allocates and re-allocates the body’s energetic resources in order to optimize fitness. Allostasis highlights the centrality of the brain as the master control center for human physiology, whose primary function is to serve as an instrument for optimal predictive regulation.
The concept of allostasis has been particularly utilized to explain the deleterious effects of chronic stress on health, where the term allostatic load developed – the “wear and tear” on the brain and body which increases over time as an individual is exposed to chronic stressors.
Homeostasis vs. Allostasis
The conventional model of regulation, homeostasis (“stability through constancy”), posits that the goal of systems is to “defend” their operational set-points. The premises for “homeostasis” originated in the nineteenth century, before evolutionary understanding, when biologists were focused on the ability of life systems to return, after a challenge, to a known constant. Bernard, Cannon, and others taught that this ability must represent an inherent tendency of biological systems to resist, or perhaps at most accommodate, change. Homeostasis considers constancy to be the normative character of life.
In contrast, allostasis posits that life entails a series of never-ending changes and challenges, and the imperative is for biological systems not to resist change but rather to optimize their operational outputs and set-points. Allostasis recognizes that, for example, the heart and lungs, digestive organs and musculoskeletal systems must share resources and shift activity patterns in concert. Thus energy can be efficiently allocated towards meeting the precise needs at hand, as well as needs which are predicted to arise in the future. For adjudication among the demands of these “competing systems,” there is a need for a master organ of regulation, and that organ is the brain.
Allostasis considers change to be the normative character of life and infers that the role of the brain is to optimize activity patterns both for itself (brain self-optimization) and distributed body organs (body self-optimization) that are all under the brain’s influence. Because of neuroplasticity, stress, and habit (allostatic load), it is possible – indeed common – for the brain’s allostatic capacity for self-optimization to be compromised.
- Adaptive vs. damaging stress
- Allostasis vs. allostatic load
- Two-way communication between brain and downstream physiology, through neural or endocrine means
- Eustress vs. bad stress
- Chronically increased heart rate and blood pressure
- The “weathering hypothesis”
- Positive and negative stress
- Flexibility is required to deal with stress
- Examples of stress (particularly stress exhaustion)
- Stress and the brain/body
- Associated with pathology
Neural oscillations are the synchronized firing patterns of large numbers of neurons. This activity is thought to play a key role in neuronal communication and the dynamic processes of cognition. A major area of neuroscience studies the roles of neural oscillations and has generated numerous experimental studies which support the functional role of neural oscillations throughout the brain.
These neural oscillations have been shown to be impacted by physical/emotional trauma spanning a range of intensity from the subtle to the near lethal. At the level of the cerebral hemispheres, oscillatory disturbances may present as asymmetries between the two hemispheres, as well as a suboptimal ratio of high frequency to low frequency oscillations. A summary of the literature on disturbed neural oscillations is provided below.
- Frontal asymmetry in brain electrical activity has long been described as a marker for affective style, with left and right frontal cortex associated with negative and positive valence, respectively.
- Other reports have associated hemispheric oscillatory asymmetry with posttraumatic stress disorder, insomnia, attention deficit disorder, autism, dyslexia, and schizophrenia.
- Numerous studies have shown the existence of hemispheric lateralization in management of the autonomic nervous system. The right hemisphere (specifically the right anterior insula) is the principle manager of the sympathetic nervous system and the left hemisphere (again, primarily the insula) manages the parasympathetic division. The lateralized management of the autonomic nervous system has raised the possibility that oscillatory asymmetry may be an indicator of dysregulation of autonomic nervous system functioning (for references, please see previous page).
Sub-optimal ratio of energy:
- Neuronal populations oscillate over a range of low (<4 Hz) to high (<70 Hz) frequencies, it is also possible to describe neural oscillatory disturbances as suboptimal proportionation of spectral brain electrical activity power across those frequency ranges.
- Attention-deficit spectrum disorders, mild cognitive impairment, dementia, and traumatic brain injury have been associated with relative excess power in low frequencies proportionally to the high frequencies.
- Other forms of suboptimal proportionation of spectral brain electrical activity have been reported with insomnia, alcoholism, and chronic fatigue syndrome.
The existence of an array of conditions which share thematic forms of neural oscillatory disturbance – asymmetry and suboptimal ratio of spectral power – suggests that a positive role may exist for technologies that may constructively impact neural oscillations in the direction of greater symmetry and optimized proportionation.
Altered patterns of activity in PET and fMRI and changes in volume, amygdala, hippocampus, pFC
Homeostasis vs Allostasis
We have, and regularly use, inner resources to release toxic stress and balance ourselves. We can take a nap, take a walk outside, take a vacation, exercise, or engage in other forms of focused relaxation. Studies have shown that stress-management techniques, including meditation, can impact brain functionality and well-being; in this way, we get ourselves “well” through the power of our own brain.
Yet many of these techniques require extensive training to be useful, and efficacy may be limited when a stress or trauma has been profound.
A revolutionary tool is now available to help the brain, help itself move back towards a state of dynamic balance through a unique intervention. It is known as, HIgh-resolution Relational Resonance-based Electroencephalic Mirroring or HIRREM®.
Similarly to other methods of deep relaxation, HIRREM is a tool to support the brain’s ability to release stress and maintain flexibility. HIRREM is a non-invasive, closed-loop neurotechnology which measures the brain’s electrical activity at high spectral resolutions and generates a series of audible tones of variable pitch and timing via intensive software algorithmic analysis, creating an acoustic brain mirror™ through peripheral auditory neural pathways. This acoustic stimulation permits resonance between the neural oscillatory frequencies and auditory tones, which appears to facilitate a state of deep relaxation and auto-calibration of neural oscillations.
Studies are currently ongoing to further investigate potential applications of HIRREM and elucidate biophysical mechanisms of action. A substantial amount of initial HIRREM research has taken place at Wake Forest School of Medicine.
Stress and the Human Body
Life provides a varied, complex, and never-ending array of challenges. People can experience them positively (leading to feelings of accomplishment and exhilaration) or negatively (leading to feelings of frustration and exhaustion), but all challenges are accompanied with some degrees of stress.
During a stress response, the brain and body communicate with each other via cascades of neurotransmitters and hormones. These responses are natural and necessary, but physiological reactions that are adaptive in the short term may ultimately damage the brain and body if prolonged. Chronic stress has a well-documented association with sub-optimal health and pathology; we get aches and pains, we can’t sleep, we succumb more easily to colds and viruses, and we are even more susceptible to developing cancer.
Autonomic System: Fight-or-Flight VS Freeze
A primary system in brain/body communication is the autonomic nervous system, composed of the sympathetic and parasympathetic nervous systems.
The sympathetic nervous system mobilizes the fight-or-flight response, preparing the brain and body for immediate action.
The parasympathetic nervous system has two branches; the myelinated “ventral vagal complex” controls the calming rest-and-digest response, while the the phylogenetically older “vegetative vagus” is associated with the full-system freeze mode.
Although the autonomic nervous system is part of the peripheral nervous system, it is subject to upstream regulation by the brain. In addition, this management has been shown in numerous studies to be lateralized in the cortex; the right hemisphere (particularly the right anterior insula) primarily modulates the sympathetic nervous system, while the left hemisphere primarily modulates the parasympathetic.
Allostasis: Flexibility and Well-Being
Autonomic responses to stress are entirely natural, necessary, and adaptive in the short term. However, the strain of reoccurring stress or trauma can cause over- or under-activation which persists even after the stressor ends, manifesting as chronic sympathetic fight/flight or parasympathetic freeze states.
Autonomic rigidity hinders optimal functioning and wellness; an autonomic nervous system “stuck” in a fight/flight or a freeze mode will be unable to relax and/or respond appropriately to future situations, potentially leading to issues such as insomnia, anxiety, chronic fatigue, or emotional numbness.
The opposite of rigidity is flexibility; the concept of allostasis connects the importance of flexibility with health and well-being. Allostasis – literally “stability through change” – defines well-being as optimal predictive fluctuation, where systems are able to not only respond appropriately to a constantly changing environment, but anticipate future demands.
The Brain as the Master Regulator
A person is composed of complex sets of interconnected systems which must be constantly coordinated, as they all share a finite energy and resources in the body. The brain fills the roll of “master regulator,” by allocating energy between the systems based on the demands our complicated environment. This ideally occurs based on current and anticipated needs, but the brain (like the body) can accumulate stress and become less flexible, staying over- or under-activated based on past demands.
The brain communicates within itself via neural oscillations (commonly called brainwaves), and the electrical activity of the evolutionarily advanced outer layer of the brain (the neocortex) can be measured non-invasively at the level of the scalp. Sub-optimal patterns in the brain’s electrical activity have been implicated in a variety of conditions including…PHYS EXAMPLES. To effectively mediate the effects of stress and regulate the body’s systems, the brain itself must be supported in its role as master regulator.
Allostasis vs. Homeostasis
Broadly, the homeostatic model is associated with the idea that the truly normal or optimal state can be defined through expert knowledge. Deviations from normality are caused by dysfunctioning of one or more mechanisms of a system’s operation. Dysfunctional mechanisms are explained reductionistically (analyzing a larger problem into smaller component processes) through controlled observations, usually based in a laboratory.
Remediation of abnormal or suboptimal states is attempted through fixing dysfunctional mechanisms, and thus the homeostatic model is generally associated with aims to control apparently dysfunctional mechanisms. Because of the complexity of systems, interventions targeted at specific mechanisms commonly produce side effects or other unintended consequences. To minimize adverse consequences, application of the homeostatic model is typically associated with high levels of specialty expertise.
The need for a new approach for understanding and action in health care (and other fields) has partly been driven by limitations of the homeostatic model for understanding and intervention. For example the placebo effect, which reflects the power of human belief on health, is repeatedly shown to be as efficacious as many complex health interventions. Conversely an environmental exposure in the form of a “non-physical” mental stressor can have very specific physical effects across organ systems. Detailed understanding of the fine mechanisms of disease often does not translate to improved therapies.
Though it is possible (and often proposed) that these anomalies simply require expansion of the homeostatic model to include more variables and complexity, an alternative is to suggest that a different view may produce a model with greater explanatory and predictive power. For example the allostatic model accounts for physical effects of positive and negative beliefs not as anomalies, but rather as the normal outcome of central neural regulation.
The allostatic model entails a more expansive view of life. It predicts that life in natural context can adapt and act in ways that reflect greater optimality than can be observed in the controlled conditions of a laboratory. Understanding and intervention are oriented toward anticipation, performance optimization, and prevention rather than reaction and remedy. In the allostatic model, specialty expertise about universal norms across systems and mechanisms tends to be de-emphasized, in favor of a respect for the unique characteristics of every individual life and circumstance.
Wellness vs. Disease Model
- Power: doctor vs. individual
- Silos of knowledge, compartmentalization
- To ameliorate single conditions, doctors can look at single organ systems
- However, to optimize functioning, a holistic view is required.
- Disease model utilizes a narrow lens to examine human experience
- Disease model of medicine exacerbates fundamental attribution error – If patients are seen through a negative lens (what is wrong with them), this can lead to moralizing the condition and stigmatization of the patient (a person is reduce to their alcohol problem or obesity or mental health issue) which reduces quality of care and can lead to missing the root of the issue. Many people who have a high BMI struggle to get quality medical attention – many physicians simply repeatedly tell them to lose weight.
- Wellness practices are empowering, and can increase self-efficacy (cite)
- Wellness practices emphasize prevention, which has been shown to greatly reduce suffering and save money. Disease management is reactive.
- Wellness practices encourage mutually respectful interaction and collaboration between doctor and patient, rather than a paternalistic “relationship”
Personalized vs. Normative
• History of normative medicine
Archives of Internal Medicine found that 13 percent of research articles published in the prestigious New England Journal of Medicine in 2009 reported reversals in medical findings involving drugs, screening tests, and invasive procedures
Today millions of North Americans are taking bisphosphonates, such as Fosamax and Aclasta, drugs designed to decrease the risk of developing brittle bones. Doctors have told consumers that this medication is effective and safe. But now the U.S. Food and Drug Administration reports that these drugs may not be of much advantage for many women. This is followed by a report in the Archives of Internal Medicine that women taking bisphosphonates are more likely to develop serious and unusual fractures of the femoral bone. This is admittedly a rare occurrence, but if it happens to you, it’s a 100 percent hit. What is more worrying is that these fractures are not the result of a fall or accident. Rather, the thighbone snaps for no apparent reason. In addition, it is not known why these drugs are linked on rare occasions to degeneration of the jawbone.
Encourages the wide use of drugs/therapies which may be very harmful to some populations, and the abandonment of others which may be highly beneficial to small populations
One size fits all? Hardly!
Assuming that all people fit into larger trends is reductive, and promotes unthinking “checklist” behavior and treatment development
BMI vs. other measures of health (remember, BMI was based on a population of middle-aged white men. A weight/height range that is “healthy” for white men is not going to be healthy for many, many other people (weight of bones, breast tissue, etc.). BMI is often falsely elevated or depressed depending on the population)
• Allostasis as a movement towards personalization of wellness practices
• Maximize strengths of a person, minimize weaknesses
• Often misses true, root cause of disease presentation – “Availability error” occurs when a doctor makes a decision based on an experience that is at the forefront of his mind but which bears little or no relation to the patient before him. For instance, a specialist in gastroenterology may only think of the gut when evaluating a woman with abdominal pain. He may not think of gynecological causes for her symptoms. The ready availability of his own specialized experience in his assessment of what is wrong with a patient can seriously bias a doctor’s judgment.
Encourages ignoring the patient’s story in favor of fitting them into a “little box,” which is easy to treat with medication.
• EEG biofeedback
Origin of that one normative database