Auditory Stimulation Therapy for PTSD

Abstract

EDUCATION: AUDITORY STIMULATION THERAPY FOR PTSD
PROBLEM STATEMENT: Clinical success has been documented for rhythmic auditory stimulation therapy for PTSD. Now, rigorous scientific inquiries into the reliability and neuroanatomical mediation of this therapeutic approach are needed.
BACKGROUND / LITERATURE REVIEW: The human body generates many internal rhythmic processes and is affected by several external rhythms. Intense musical emotion is associated with brain regions thought to be involved in reward, motivation, and arousal: the ventral striatum, the amygdala, the midbrain, and regions of the frontal cortex. The Bio- Acoustical Utilization Device (BAUD) has been used successfully for rhythmic auditory stimulation therapy for post-traumatic stress disorder (PTSD) in a clinical method called Reconsolidation Enhancement by Stimulation of Emotional Triggers (RESET Therapy).
CASE PRESENTATION: In one case, RJL, a Vietnam vet gunner dealt for 50 years with such problems as "sleep disorder, drug use and overwhelming anxiety..." After one RESET treatment, the patient's wife reported that "He went home, slept well, didn’t jerk awake, didn’t jump up awake slamming, screaming, looking like someone was going to kill him.” In another case, there was similar relief for Afghan vet WR, tormented by memories of an IED explosion that killed and injured children. Quantitative EEG brain mapping of WR before RESET Therapy indicated lack of cortical control over the limbic system, left frontal lobe hyper-activation in the speech regions, and evidence of disrupted executive functioning ability. These indications were completely absent in the post-therapeutic qEEG map. Evidence for the functional neuroanatomy that may mediate these remarkable effects is present in two lines of investigation. Auditory steady state evoked potential (SSEP) research suggests that “through the acoustical pathway we are able to directly modulate neural activity in the amygdalo-hippocampal circuit during memory retrieval and reconsolidation.” Studies of auditory fear conditioning indicate that auditory stimulation, fear, the medial geniculate nucleus of the thalamus, and the basolateral complex of the amygdala are intertwined.
OPERATIONAL / CLINICAL RELEVANCE: The clinical successes with RESET Therapy need applied research attention. There is a promise here of relief from disabling PTSD symptoms for combat veterans and for active duty personnel.

Full text

AUDITORY STIMULATION THERAPY FOR PTSD
James C. Miller, Ph.D.
Consulting Scientist, Buffalo, WY
Air Force Research Lab (retired), San Antonio, TX
Vietnam Veteran C-130 Pilot
George Lindenfeld, Ph.D.
Neuropsychology, Lindenfeld & Associates, Sarasota, FL
Neuropsychology, Medical Psychology Center, Asheville, NC
88th Annual Meeting of the Aerospace Medical Association,
Denver CO, May 2017

Auditory Stimulation Therapy for
PTSD
The human body generates and is affected by external rhythmic processes.
Walter B. Cannon, 1916: importance of rhythmic drumming and music in
human motivation.
Recent clinical success with rhythmic auditory stimulation therapy for post-
traumatic stress disorder (PTSD).
Bio-Acoustical Utilization Device (BAUD) used in a clinical method called
Reconsolidation Enhancement by Stimulation of Emotional Triggers
(RESET).
Focus here: The neuroanatomical mediation of BAUD/RESET therapy and
the need for relevant research.

Rhythmic Sound & Emotion
“A careful consideration of the use of martial music in warfare would perhaps
bring further interesting evidence that its function is to reinforce the bodily
changes that attend the belligerent emotions.” Walter B. Cannon, Bodily Changes..., 1916,
p. 228 (emphasis added)
“[I]ntense musical emotion … was associated with brain regions thought to be
involved in reward, motivation, and arousal: the ventral striatum, the amygdala,
the midbrain, and regions of the frontal cortex.” Blood et al., Emotional
responses to pleasant and unpleasant music correlate with activity in paralimbic
brain regions. Nat. Neurosci. 1999 Apr;2(4):382–387. Levitin, p. 189.
“Metrical extraction, knowing what the pulse is and when we expect it to occur, is
a crucial part of musical emotion.” Daniel J. Levitin, This is Your Brain on Music, 2006, p. 172
(emphasis added)

PTSD Therapy
“Talking” and psychotropic drug treatments: 50% success in reducing some
symptoms.
Dr. George Lindenfeld's work on rhythmic auditory stimulation therapy for post-
traumatic stress disorder (PTSD). Surprising 100% success on reducing or
eliminating all symptoms.
SO, Army paratrooper, Green Ramp Disaster - Pope AFB, NC
RL, Army, 1st Sergeant, Iraq
RC, Army Medic, Iraq
RL, Army Infantry, Vietnam
PR, Marine, Vietnam
Trudie B, Army, Military Rape & IED, Afghanistan

BAUD
Bio-Acoustical Utilization Device
In therapy, patient revisits the “triggering event” as though it were actually
happening before him/her, then sets two volumes & frequencies.
Right ear: adjustable volume & fundamental frequency of 39 to 362 Hz. Patient
(Pt) sets this 1st to “resonate” with event.
Left ear, “disruptor”: adjustable volume & selected fundamental frequency
plus 0 to 20 Hz. Pt sets this 2nd to disrupt memory.
Result: binaural modulated
tone with beat frequency of 0
to 20 Hz.
Modulation is “most always
set in the 4-8 Hz theta range.”

QEEG

WR's QEEG
Pre and Post RESET Therapy
Lindenfeld, G., & Rozelle, G. (2015, December 12). “PTSD: Brain on Fire: A RESET Therapy (QEEG)
Brain Map Analysis of an Afghanistan Combat Veteran.” Academia.edu. Retrieved from academia.edu.

Other Lines of Evidence
What else do we know about the functional neuroanatomy that may mediate
these therapeutic effects?
Supportive evidence is present from at least three lines of investigation:
(1) the auditory steady-state evoked potential,
(2) investigations of fear conditioning, and
(3) the effects of deep brain stimulation in humans.

Auditory SSEP
Brain electrical activity responds rhythmically to flashing strobe lights (up to 100
Hz) and to rhythmic clicking:
Auditory SSEP elicited in the scalp EEG “with modulated tones ... The
response itself is an evoked neural potential that follows the [frequency]
envelope of a complex stimulus. It is evoked by the periodic modulation, or
turning on and off, of a tone [clicking]. The neural response is a brain potential
that closely follows the time course of the modulation. The response can be
detected objectively at intensity levels close to behavioral threshold.” Stach, B.,
Washington University, St Louis, The auditory steady-state response: A primer. The Hearing Journal,
2002 Sep;55(9):10.Hearing Journal, 2002. (emphasis added)
My review of the relevant neuroanatomy literature... Miller, J. C. (2016, July).
“Therapeutic Auditory Stimulation and the Auditory Steady-State Evoked Potential.” Retrieved from
academia.edu.

Anatomic Limbic System
Traité d'Anatomie et de Physiologie (1786)

Auditory Fear Conditioning
Sound has a direct, unfiltered pathway to the amygdala through the auditory
thalamus (medial geniculate nucleus). Spreng (2000). Noise & Health, 2(7), 49–58.
(emphasis added)
Rhythmic activity in the amygdala (BLA) at the theta frequency during arousal ...
may promote plasticity in co-active structures of the temporal lobe. Paré (2003).
Prog. Neurobiology, 70(5):409–420. (emphasis added)
The re-consolidation of remote contextual fear memory includes changes in
ensemble activities between the lateral amygdala and hippocampal area CA1.
Narayanan et al. (2007). Neuroreport, 18(11), 1107–1111.
Trauma creates potentiated neural circuits in the limbic system, especially the
amygdala, that perpetuate problematic emotions. Francati et al. (2007). Depression
and Anxiety, 24(3), 202–218.
Aversive sound has an arousing effect on the amygdala. Kumar et al. (2012). J.
Neuroscience, 32(41), 14184–14192. (emphasis added)

Deep Brain Stimulation (DBS)
Can deep brain electrical stimulation change emotional behaviors? Yes.
Perhaps analogous to auditory stimulation.
Significant changes in plasma corticosterone levels were obtained following
stimulation of hippocampal and amygdaloid areas. Dunn & Orr (1984). Experimental
Brain Research, 54(1), 1–6.
“[I]n the same manner as for movement disorders, surgery that targets the [basal
ganglia]–thalamocortical loop can restore normal cortical activity associated
with behavioural and mood disorders. DBS for the treatment of psychiatric
disease is compatible with the notion that neurological and psychiatric
diseases share essential neurobiological mechanisms.” Krack et al. (2010). Trends
in Neurosciences, 33(10), 474–484. (emphases added)

Conclusions about Functional Neuroanatomy
These knowns:
The effects of rhythmic sound on emotion,
The functional neuroanatomy of auditory linkage to the limbic system,
The functional neuroanatomy of limbic system interactions associated with
fear conditioning, and
The effects of deep brain stimulation on emotional behavior
Taken together support the contention that “through the [auditory] pathway we
are able to directly modulate neural activity in the amygdalo-hippocampal
circuit during memory retrieval and reconsolidation.” Lindenfeld, G., & Bruursema, L.
R. (2015, May 28). “Resetting the Fear Switch in PTSD...” Academia.edu.

Conclusions about Functional Neuroanatomy
Investigations of various BAUD-based RESET approaches to PTSD therapy are
indicated.
Additionally, research investigations are needed to clarify the probable functional
neuroanatomy that mediates the success of the therapeutic approach.

RESET Therapy
Given that clarification is needed of its probable functional neuroanatomy,
investigations of various BAUD-based RESET approaches to PTSD therapy
are beginning.
RESET therapy objectives (common for memory-based therapies)
Re-stimulate the reactive limbic portion of the targeted neural circuit, through
patient's attentional focus plus auditory stimulation.
Introduce a modifying stimulus: a disruptive theta-pulsed sound that
interrupts the reconsolidation of the hyperactivated or sensitized memory
circuit.
Expectation: normalization of a hyperactivated or sensitized memory circuit
usually takes place immediately or within 24 hours following the first
treatment session.

1st Experiment Underway
PTSD patients, n = 36
Pre: questionnaires, test of reasoning ability, QEEG
2 to 4 RESET sessions
Post: questionnaires, test of reasoning ability, QEEG
3- and 12-month follow-ups: questionnaires, test of reasoning ability,
QEEG
Self-funded, equipment on hand, experimenters' time

Questions?
AUDITORY STIMULATION THERAPY FOR PTSD
James C. Miller, Ph.D.
Consulting Scientist, Buffalo, WY
jcmiller@fastmail.us
George Lindenfeld, Ph.D.
Neuropsychology, Lindenfeld & Associates, Sarasota, FL
glindy123@gmail.com