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Clinical Audit Study on Gupta Amygdala Retraining

Discussion in 'Alternative Therapies' started by budd, Sep 21, 2010.

  1. budd


    Hi - I have been reading this forum for 2 years now, I have never posted before, but I did so because I wanted to get the opinions of the critical thinkers who come here. I got this email (below) from Ashtok Gupta about the results of a 'clinical audit' of the Gupta Amygdala Retraining program.

    I am trying to discern:

    1) if this is a trial conducted by Gupta himself or by an independent/impartial scientific body
    2) if the Journal of Holistic Healthcare is a respected publication rather than a marketing magazine

    Also, any idea if the if/when the Mayo clinic will release results of it's study on the Amygdala Retraining program?



    I am pleased to announce the publication of the Clinical Audit Study this month on Gupta Amygdala Retraining treatments for ME/CFS, Fibromyalgia and MCS. It is hoped that the positive initial results shown in this paper will stimulate funding for further research into the treatment. Feel free to forward it to people who may be interested, or post it on online forums and blogs.

    Amygdala Retraining has come on leaps and bounds since this Clinical Audit was conducted, so we hope for even better outcomes in future studies.

    The PDF version of the published paper with diagrams can be downloaded here:


    Journal of Holistic Healthcare Volume 7 Issue 2 P12-15 September 2010


    Ashok Gupta MA(Cantab), MSc
    Director, Harley Street Solutions |


    The clinical audit to assess the effects of amygdala retraining techniques (ART) on patients with chronic fatigue syndrome (CFS), studied 33 patients (average age 37.8, male-female ratio of 1:2) with a confirmed diagnosis of CFS based on international criteria. They were recruited for one-year. Participants consented to take part in the audit, and the techniques were taught in detail to them. Initial self-assessments of functional abilities were taken at the start and one year after treatment.

    Results: 93% of participants reported improvement. Two thirds of participants (67%) made considerable recoveries reaching 'full functioning' (80-100% of pre-illness levels). Six participants dropped out of the survey.

    Conclusions: The clinical audit revealed higher rates of improvement in comparison to the natural remission rate in other intervention studies. Further randomised controlled studies are recommended to test the efficacy of ART.


    Chronic fatigue syndrome is estimated to affect around 250,000 people in the UK. The clinical audit describes a pilot programme of a previously unpublished set of therapies known as amygdala retraining techniques (ART). This holistic set of treatments is underpinned by a medical hypothesis published in 2002 (1) which implicates neurological trauma in the amygdala as the primary cause of CFS. This clinical audit was designed as a preliminary assessment of the effects of ART, and to prompt further research into its methods.

    Amygdala retraining therapy is based on my novel hypothesis for the causes of CFS. I have suggested that following a 'traumatic event involving acute psychological stress (possibly combined with other dysregulating factors such as a viral infection or other chemical or physiological stressors), the amygdala may - through a conditioning process - become chronically sensitised to signals arising from the body. These signals from the viscera (perhaps triggered by physiological, chemical or dietary stressors) become conditioning stimuli. The insular cortex may be involved in the process, as it interprets the emotional meaning of the symptoms, and passes that representation on to the amygdala. The conditioned response which is driven by the amygdala through its connections to various brain pathways including the hypothalamus, provokes a chronic over-activation of the sympathetic nervous system (SNS).

    Certain neurologists conceptualise the neurological basis of conditioned responses as a network of neurones that create a specific output from a specific input. In these terms, it is such conditioning that produces the CFS vicious circle, which is triggered by an unconscious negative reaction to disturbing symptoms which in turn produces a state of chronic sympathetic over-activation. Eventually this may provoke sympathetic and immune dysfunction, as well as mental and physical exhaustion, and a host of distressing symptoms with secondary complications. However, because such symptoms are perceived as the sort of threat the insular cortex, amygdala and its associated limbic structures monitor and respond to, an amplifying feedback loop is likely to ensue. In effect, the amygdala having first become conditioned to hypervigilance to threat, upregulates the SNS, thereby producing bodily signals which drive rising levels of alarm, further increasing hypervigilance.

    It is hypothesised that recovery from CFS might involve the development of neural pathways from the medial prefrontal cortex to the amygdala, which can control the amygdala's over-sensitivity. This hypothesis was based on evidence from the work of Professor Joseph Ledoux, whose animal experiments over the past two decades linked the amygdala function to the monitoring of threat, and emotional responses including fear. (2) This has become a generally accepted neurological model for these responses. Ledoux's work emphasises the part played by external stimuli, for example electric shocks administered to rats. My 2002 paper1 emphasises that conditioned fear reactions could just as easily occur in response to internal stimuli, ie symptoms in the body. Ledoux was also able to link the extinction of these fear responses to neural pathways from the medial prefrontal cortex to the amygdala that potentially reduce the amygdala's fearprovoking over-sensitivity. If this neurological
    conditioning of the amygdala also occurs in CFS, the vicious circle described previously is likely to continue until this extinction occurs and the amygdala's reactions are subdued.

    Quirk et al (3) in their work on the neurobiology of extinction processes, state that 'extinction is new learning, rather than erasure of conditioning'. This implies that rather than erasing the original fear-conditioning pathways from the amygdala to the cortex, a new neuronal pathway has projected from the medial prefrontal cortex back to the amygdala to control it. ART aims, through a variety of techniques, to encourage this extinction process by the developing the so-called 'safety neurone'. These techniques for down-regulating the amygdala's reactions to bodily symptoms were developed over many years of working in a private clinic, during which at least 200 patients were treated.

    It has to be emphasised that the neurobiological basis of the ART amygdala model as applied to CFS is currently difficult to test, and there is as yet no proof that the therapies developed are actually targeting this underlying neurological process. At this stage, both the hypothesis and treatments are work in progress, and only further research will establish the underlying mechanisms by which they might work. Real-time functional brain scanning before and after treatment, for instance, would be a useful avenue for future research. There are, however, some interesting parallels between the possible neurobiology of recovery from CFS, and extinction processes of fear responses in other conditions, most notably post traumatic stress disorder (PTSD). In PTSD, Milad et al, (4) conducted a review of human studies which indicated that 'PTSD is characterized by failure of the mPFC (medial prefrontal cortex) to sufficiently inhibit the amygdala', and that 'prefrontal areas homologous
    to those critical for extinction in rats are structurally and functionally deficient in patients with PTSD'. In CFS, there have also been studies which have found abnormalities in the prefrontal cortex. Okada et al (5) reported an average 11.8% reduction in grey-matter volume in the bilateral prefrontal cortex in patients with CFS compared to healthy controls, a volume reduction which paralleled the severity of the fatigue of the patients. Furthermore, de Lange et al (6) reported that 'there is a significant increase in pre-frontal grey matter volume as a result of CBT in CFS patients', and that the degree of success of CBT outcome was related to the degree of recovery in grey-matter volume in the lateral prefrontal cortex'. Once again, these parallels do not in themselves prove the connection between the amygdala and CFS, but they do tentatively support the hypothesis that CFS may ultimately be a brain disorder, where the function or structure of the prefrontal cortex is
    affected such that its ability to control the amygdala's expression may be compromised.

    The amygdala retraining techniques have been specifically designed to attempt to create a hypothesised 'safety neurone' from the cortex to the amygdala, by inducing a relaxation response each time the conscious mind is alerted to a symptom. I observed in my 2002 paper that patients may find it difficult to 'take their minds off their bodies', possibly because the amygdala is constantly arresting conscious attention due to its conditioning. Amygdala retraining techniques involve repeatedly interrupting the signals from the amygdala using a variety of techniques tailored to each patient. The patient is taught to recognise a fearful internal response to symptoms, and then to act on these feelings in a way which dramatically interrupts that anxiety or fear. At the end of the process, a relaxation signal is hypothesised to be sent to the amygdala using a form of NLP visualisation called an 'anchor for health'. It could be hypothesised that this final relaxation response aims to cr
    eate and strengthen the 'safety neurone' from the cortex to the amygdala.

    One of the meditative techniques called 'soften and flow', is designed to deliberately calm the mind's responses to symptoms through gentle awareness of symptoms in a meditative state. Anecdotally, patients report feeling more relaxed about their symptoms following these exercises. Lazar et al (7) found 'brain regions associated with attention, interoception and sensory processing were thicker in meditation participants than matched controls, including the prefrontal cortex and right anterior insula'. As before, this neurobiological finding allows tentative links to be made between the structure and function of the prefrontal cortex, and one of the amygdala retraining techniques.

    The breathing technique used is called 'alternate nostril breathing', derived from yogic breathing practices. Another technique is a basic meditation where a patient is asked to focus on their pattern of breathing.


    The participants were recruited from CFS patient support groups in the UK. Advertisements were placed on support group websites, offering free treatment using a new experimental set of therapies, based on a new hypothesis. The participants were all asked to confirm that they had been diagnosed with CFS by a doctor who had excluded other possible causes through biomedical tests. They were also asked to confirm the presence of symptoms against the 1994 CDC international criteria for CFS.

    The average age of the participants was 37.8 years (SD+/- 10) years, and the average number of years of suffering from the condition was 10.5 [SD +/- 9] years. The range of duration of the illness was from 2 to 40 years, and two thirds (67%) of participants were female.

    Each participant was asked to state initially what percent of normal physical activity levels and functional abilities they were currently capable of. They then received treatment over the following six months consisting of a single face-to-face session with the author lasting 2.5 hours in which the techniques of ART were explained and taught. Participants were followed up weekly or fortnightly by telephone to check that they were complying, and to encourage correct use of the techniques. The ART techniques, holistic dietary, lifestyle, stress management, and self awareness treatments designed to work together to enhance the overall process were tailored to each participant, though they were applied equally to all participants within the programme. The stress tools and techniques took a minimum of 30 minutes a day in one sitting (meditation, 'soften and flow', and alternate nostril breathing), along with some short NLP-based 30-second tools used throughout the day, as and whe
    n required. Compliance varied amongst the participants. However, it was known that at least three of the participants were undertaking other treatments concurrently, and it is quite possible that others may have been. Undoubtedly this unknown variable will have been a confounding factor.

    The participants were assessed over a year after the treatment using a simple qualitative self-assessment questionnaire which had been tried out on three participants to test its sensitivity. The questionnaire noted the participant's assessment of functional ability (out of 100%), and information on improvements in levels of physical, mental and emotional functioning. Finally participants were asked to comment on their plans for the future.


    Out of the total 33 participants, 27 participants completed the programme. Comparing the percentage self-assessment score out of 100 for each participant, 93% of participants (25 out of 27) reported improvements in functioning levels. Pre-treatment, the mean functioning score was 41.5% (+/- 16.0) which improved to a mean score of 77.0% (+/- 27.6) post-treatment. Two thirds of participants (18 out of 27) made considerable recoveries reaching 'full functioning', where full functioning is defined at being 80-100% of pre-illness levels (pre-treatment 47.9% +/- 13.9, post-treatment 94.2% +/- 4.7).

    These participants stated that they did not feel that they were suffering from CFS any more, and instead that they were in a transition phase from being ill to adjusting back into normal life. Out of 27 participants, 15 reported a 90-100% recovery (pretreatment 47.8% +/- 14.4, post-treatment 94.8% +/- 4.2). A minority of participants (two) noticed no significant physical improvement, although there were self-reported improvements in psychological wellbeing in both of these participants.

    The six participants who dropped out did so within the first month. They stated that their reasons for leaving included having too much going on in their lives to commit to practising the techniques, or prioritising another treatment. The 18 (67%) participants who reached 'full functioning' were very pleased with the progress they had made, and some were surprised at the speed with which occurred. During the recovery process, many participants commented that they had ups and downs, though we found no obvious overall pattern to the recovery process. They commented that persistence with the techniques was essential. Most participants at the 80-100% functioning mark stated that they did not class themselves as having CFS anymore, but rather were simply adjusting to normal life again. Many were looking for part-time or full-time work, or indeed had re-entered the workplace already. Out of the 18 participants who had reached full functioning, 13 have already begun full-time work.

    The qualitative data gathered could be summarised into key themes:

    . Physically, participants felt that they were able to do much more without the post-exertional malaise that usually accompanies the condition, with many participants able to engage in a moderate workout at the gym.

    . Mentally, with respect to cognitive function, better concentration and memory was highlighted as a key benefit, as well as no 'brain fog'.

    . Emotionally, the vast majority of participants regarded themselves as much less anxious, and coping skills and strategies were very much improved. When asked about the future, participants who had reached full functioning spoke of returning to full-time work (if they not done so already). Others who had not reached this level of functioning were generally optimistic that as long as they kept up the techniques, they would hope to see further progress.


    The findings of this survey indicate that improvements in health were achieved with the vast majority of participants (93%). Furthermore, for a significant majority of participants (67%), they achieved 80-100% functioning of pre-illness levels. In comparison, standard placebo group improvement rates in intervention studies are in the region of 6-20%. (8)

    A recent comparative study by Jason et al (2007) (8) reported significant improvement rates of 28% for cognitive therapy, 20% for cognitive behaviour therapy, 16% for anaerobic activity, and 12% for relaxation therapy. However it was noted in Jason's study that the vast majority of patients still continued to be diagnosed with CFS. Research comparing ART with cognitive behavioural therapy (CBT) would be useful.

    One of the key challenges with the application of ART is its holistic nature. Each participant brought their own unique personal and lifestyle issues with them and therefore it was important for the therapist to personalise the combination of tools and techniques for that patient. My belief that better outcomes can be achieved using this approach than by using a standardised therapy would also need to be tested further in any future study.

    As an initial clinical audit, there were methodological limitations, and a further randomised controlled study using standardised measures will need to be conducted to establish whether ART is in fact an effective treatment. Only then can further steps be taken to incorporate this individualised approach to treatments into primary and secondary care provision.


    No control group or placebo group was used, and future studies would need to incorporate this. No standardised tools were used, and randomised collection was not employed. Researcher bias, and the effects of researcher/practitioner enthusiasm, were significant confounding factors, as were participants' possible use of concurrent therapies. Sample bias was significant in that those completing the programme may have shown more motivation and commitment.


    The clinical audit of the ART approach suggested higher rates of improvement in comparison to the natural remission rate reported in other intervention studies. Further double-blind/randomised studies are recommended to test the efficacy of ART.


    Thank you to all the patients for participating. Thanks also goes to Dr Mohan Pawa for his contributions and advice, as well as Karen Goldman for her help with this paper.


    1. Gupta A. Unconscious amygdalar fear conditioning in a subset of chronic fatigue syndrome patients. Medical Hypotheses 2002; 59 (6): pp727-735.
    2. Ledoux J. The emotional brain. London: Weidenfeld & Nicolson, 1998.
    3. Quirk GJ, Garcia R, Gonzlez-Lima F. Prefrontal mechanisms in extinction of conditioned fear. Biol Psychiatry 2006; 60(4): pp337-43.
    4. Milad MR, Rauch SL, Pitman RK, Quirk GJ. Fear extinction in rats: implications for human brain imaging and anxiety disorders. Biol Psychol. 2006; 73(1): pp61-71.
    5. Okada T, Tanaka M, Kuratsune H, Watanabe Y, Sadato N. (2004). Mechanisms underlying fatigue: a voxel-based morphometric study of chronic fatigue syndrome. BMC Neurol 2004; 4 (1): p14.
    6. de Lange FP, Koers A, Kalkman JS, Bleijenberg G, Hagoort P, van de Meer JW, Toni I. Increase in prefrontal cortical volume following cognitive behavioural therapy in patients with chronic fatigue syndrome. Brain 2008; 131 (8): pp2172-2180.
    7. Lazar SW, Kerr CE, Wasserman RH, Gray JR, Greve DN, Treadway MT, McGarvey M, Quinn BT, Dusek JA, Benson H, Rauch SL, Moore CI, Fischl B. Meditation experience is associated with increased cortical thickness. Neuroreport 2005; 16: pp1893-7.
    8. Jason LA, Torres-Harding S, Friedberg F, Corradi K, Njoku MG, Donalek J, Reynolds N, Brown M, Weitner BB, Rademaker A & Morris Papernik. Non-pharmacologic interventions for CFS: A randomized trial. Journal of Clinical Psychology in Medical Settings 2007; 14 (4): pp 275-296.

    Further Information and Links:
    - To view videos with further information on the Amygdala Retraining Programme, please visit
    - Ashok Gupta will be conducting a workshop on his techniques on the 15th-16th of October in London, details here:
    - To view Ashok's Draft Medical Paper on The Amygdala Hypothesis and XMRV Virus Findings, click here:
    - The PDF version of the published paper can be downloaded here:
    Harley Street Solutions

    Administrative Office
    5 United House, Mayflower Street
    London, Greater London
    SE16 4JL
  2. ukxmrv

    ukxmrv Senior Member

    Here's the editor of the journal

    Professor David Peters read more Dr David Peters (editor-in-chief) is Professor of Integrated Healthcare and the Clinical Director in the University of Westminster's School of Life Sciences. He is a musculoskeletal medicine specialist, a former GP, and an osteopath. He directed the R&D programme for complementary therapies at Marylebone Health Centre (MHC) and is member of the Prince of Wales' Foundation for Integrated Healthcare's Advisory Board. David has co-authored or edited five books about integrated healthcare. "My R&D interests include the use of non-pharmaceutical treatments in mainstream medicine, how to promote wellbeing €“ particularly in long term conditions - and the development of integrated practitioners and integrative practice". close


    Uni of Westminster is what used to be our local polytechnic before all the changes in the UK. I had the misfortune of once being a patient at the Marylebone Health Centre mentioned above. Appalling level of service and appalling attitudes to people with ME (in my experience).

    Personally I wouldn't touch Gupta or this publication with a bargepole but appreciate that others feel differently. Met local people who have done it and been amazed by their experiences (bad or no real change).

    Have a read of their "contributors guidelines" to get a feel of this magazine

    "JHH is a platform for holistic ideas, authentic experiences, and original research. We
    estimate our regular (and growing) circulation of 800 copies is read by as many as
    2000. And, though we don’t yet attract researchers seeking RAE points, we are free
    to be a voice for the kind of ideas, reports, experiences and social inventions that
    wouldn’t fit easily into more conventional mainstream journals: small studies, pilots,
    local reports, surveys and audits, accounts of action research, narratives,
    dissertation findings (otherwise hidden in the grey literature), pragmatic and
    qualitative studies and practice evaluations. "

  3. budd


    Thanks for the info ukxmrv.

    I will highlight the compelling findings - but given what ukxmrv has to say, it is is likely they should probably be taken with a grain of salt:

    "...93% of participants (25 out of 27) reported improvements in functioning levels...Two thirds of participants (18 out of 27) made considerable recoveries reaching 'full functioning'...
    These participants stated that they did not feel that they were suffering from CFS any more...Out of 27 participants, 15 reported a 90-100% recovery..."

    It will be interesting when the Mayo clinic releases their data on the Gupta program. Is there anyone who knows when that will be and if their studies are independent and repected in the scientific community?
  4. *GG*

    *GG* senior member

    Concord, NH
    Circulation of 800 copies? Does not sound impressive at all! LMAO
  5. I did (am doing) the Gupta method very conscienciously, now for 15 months, and think it has done nothing for me in terms of improving my physidcal abilties. However it is a good method to use for keeping positive and maintaining a belief that you will get better. I think there must be many psychologists who could have made a similar program - and perhaps cheaper. However having paid the NZ$400 I may as well use it and do so as taught, I feel it is a crutch for me- I know I am doing everything I can to get better. But physically it has been hopeless - I have been very conscientious about doing it as prescribed and using the methods and dvds.
  6. zoe.a.m.

    zoe.a.m. Senior Member

    Olympic Peninsula, Washington
    I remember when word of this program really broke and I was curious about how it might very well be helpful for chronic illness, but why it wasn't being marketed for all people with a chronic illness...? Your experience confirms my issues with it and its marketing; mainly, that, like many other treatments, it seems to work for a subgroup (and no one really knows why that subgroup--and the "international criteria" Gupta mentions is typical of his evasion about who/how it helps).

    I'm glad it's given you some help with staying positive and I hope you don't doubt yourself at all because it hasn't been able to overcome your physical limitations.
    CantThink likes this.
  7. island-grace

    island-grace member

    southern Germany
    I suffered from CFS from 2004-2008, when I found the Guptaprogramme and it worked for me quite reasonably. Today I consider myself fully recovered. I think I understand how and why this worked for me, but I also understand that many others are facing more difficulties.
    I think there is a chance to overcome the difficulties with the help of a coach. There is something very deep about this program, and many who are doing the program, be it even very conscientionsly, may miss out or pass over the crevices where to enter into this depth. A coach who fully understands the process might be able to help.
    Please take into account my limited ability of expression, seen that English is not my first langage.
  8. island-grace

    island-grace member

    southern Germany
    Frankly, guptaprogramme worked for me. So I'm a member of the lucky subgroup. You will imagine how happy I am that I excaped this verdict of lifelong illness!
    But I don't feel like subgroup. I feel like I had definitely had CFS, went through all the stages of misery: not knowing what is wrong with you, ignorant doctors, pains allover and all day round, dreadful exhaustion, post-excertional malaise etc.
    As regards your issues with the marketing, I think Ashok did whatever he could. He was facing so much resistance and closedness from all parties.
    He would have needed the support of whatever medical association for things to turn out better.

    Did you try the help of a coach? Maybe Ashok is promising a bit too much by saying you will recover just from the DVDs and the exercises. Although it's not impossible: I did it. The assistance of a coach could, in my eyes, considerably enhance the percentage of people with full recoveries. But that will cost additional money that sick people generally don't have. That's a serious issue so far.
  9. kday

    kday Senior Member

    If the Gupta DVD was under $50 I would get it.

    I've gambled lots of time and money for many different types of psychotherapeutic interventions, and nothing really worked. Some ideas helped, but nothing really improved my overall well-being. Neurofeedback and biofeedback wasn't much help. Seeing a psychologist was a disaster. EFT is not much help for me. Breathing techniques can help a little; not much. Hypnosis probably works the best for me out of anything I tried, but only provides short term and limited relief.

    I find it suspicious that somebody created a new account to share their success. I am not saying this person wasn't a true CFS sufferer, but I have the right to remain skeptical.

    If somebody would pirate the DVD and post it online, I'd be happy to download it and give it a try. Make it $50 or less, and I would buy it. If this therapy is as remarkable as it claims, I truly think the price point is discouraging most people from giving it a try. Although I haven't analyzed the market, I honestly think the DVD could be much more profitable for Ashok Gupta at a lower price. Perhaps I am wrong.
  10. *GG*

    *GG* senior member

    Concord, NH
    (Mod edited)

    Do you have a lot of pain? Have you tried meditation?

  11. Cort

    Cort Phoenix Rising Founder

    Congratulations on your success. I certainly do recognize the benefits from reducing stress ful thoughts and feelings given how 'aroused' my system seems to be. Gupta is not an easy program to follow but it did improve my quality of life but unfortunately had no effect on my ability to exercise. I continue to explore similar practices - sometimes they work and sometimes they don't.
  12. Sean

    Sean Senior Member

    Sorry, but this is just too vague, subjective, confounded and uncontrolled. Same as all the other behavioural studies. This study does not prove anything much more than patients tend to subjectively report doing better when some effort is made to manage their stress levels. Which is fine for helping to reduce the consequences of being sick, but it is nothing of any great relevance to our underlying health problems that caused the stress in the first place.

    And I think his rationale for the program is extrapolating too far from what we know about neurobiology. It is just too simplistic. Rats (or dogs) in laboratory cages are not human beings in the real world.

    But I will give him considerable credit for being fully transparent about the serious limitations of this study. If only all behavioural studies were so honest.

  13. heapsreal

    heapsreal iherb 10% discount code OPA989,

    australia (brisbane)
    I can understand his treatment as a coping strategy which seems to be how alot of people find it, but if a viral or retroviral cause is the problem , does this shoot down his arguement as a cure for cfs and are the people who do get cured from his therapy misdiagnosed as having cfs/me, possibly anxiety, depression or some other neurological condition. If he still think his treatment is a cure for cfs/me, then would it have merits in treating HIV, hepatittis etc. I havent read this whole thread but these are things that cross through my mind when amygdala training is mentioned. Im not trying to start an arguement but these are my thoughts and i think that its just promoting cfs/me as a psychological condition that we have been trying hard to get away from for so many years and all of studies showing viral and immune system involvement mean nothing. I also havent read alot about amygdala training as the concepts clash with my thinking of immune system invovlement, so doesnt make alot of sense to my way of thinking, but im open to being wrong.


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