My Fisher Wallace Cranial Electrotherapy Stimulator Has Arrived!

I came home from working at the church and noticed a small package on the front steps. I couldn’t remember anything of this size I had ordered, so I walked inside and slide it open – to my surprise, there was the Fisher Wallace Stimulator! I’d purchased it on Tuesday (7/9) and received it the next day (7/10). I don’t expect everyone will get it that fast – but I’m glad it miraculously came so quickly to me. Here is a photo of what you see when you open the box:

Opening the Package from Fisher Wallace.
Opening the Package from Fisher Wallace.

I took out the pouch and unloaded its contents, which look like this:

Everything that comes inside of the pouch.
Everything that comes inside of the pouch.

I must say that the first thing that impressed me was the presence of two Duracell batteries. I know, I know, its a very small thing – but doesn’t it just drive you nuts when you get an electronic device and it doesn’t have the batteries!?!? Well, it drives me nuts. Lets take a closer look at the different components:

Fisher Wallace Stimulator - Frontal
Fisher Wallace Stimulator – Frontal

This is the stimulator. Looks pretty simple. The bottom light indicates the device is on, the lights with numbers indicate how high of intensity it is running at – they recommend starting at two. Despite my great desire to start at four, I started with two.

Fisher Wallace Stimulator Without Batteries
Fisher Wallace Stimulator Without Batteries

Flip the device over and pop off the battery cover and this is what you’ll see. Nothing too fancy, but note the nice belt clip. This is where I first had problems. There are two little hooks at the bottom of the battery cover that need to slip in a certain way and it took me a few tries (nothing major) to get them in. Then I picked it up and the battery cover fell off! What?! I realized that at the top there is a little latch which can be pressed up or down (most simply snap in, which probably makes them more likely to break – so I think this is a better design). Once I had actually latched the battery cover shut, everything was good.

Fisher Wallace Wire Connectors
Fisher Wallace Wire Connectors

Now these wires plug into the stimulator and then into sponge covers which attach to my head. Looks a little frighteningly like I’m getting ready to jump start a car battery, no?

Fisher Wallace Stimulator Sponges/Holders
Fisher Wallace Stimulator Sponges/Holders

This is the front of the sponge containers. Fisher Wallace kindly inserts the first set of sponges for you.

Fisher Wallace Stimulator Sponges After Soaking
Fisher Wallace Stimulator Sponges After Soaking

And here are the sponges after I’ve soaked them in the sink. Not sure if you can tell from the photo but they have expanded significantly.

Fisher Wallace Stimulator Waiting to Be Used.
Fisher Wallace Stimulator Waiting to Be Used.

It only took a few minutes, but now she is ready to go…So, I latch her onto my belt and start her up.

Fisher Wallace Stimulator attached to belt, powered on.
Fisher Wallace Stimulator attached to belt, powered on.

I had no problem attaching it to my belt and you can see the green light says that it is on and the two yellow lights say that it is at level 2. Note that they are actually flashing, but that doesn’t show up in a still photo. ūüôā

Dave wearing Stimulator without glasses.
Dave wearing Stimulator without glasses.

And here I am wearing the stimulator…but that isn’t really what I look like when I’m using it, b/c I use reading glasses…it’s more like this:

Dave Wearing Stimulator with Glasses
Dave Wearing Stimulator with Glasses

Yes, that is a little more dorky/geeky looking, like it should be.

Dave Wearing Stimulator Ear Shot
Dave Wearing Stimulator Ear Shot

I also took a close up shot so you can see how the sponge/sponge cover fits under the headband immediately above my sideburns.

Now I did have one other small problem. At first the device was powering on and showing one level 1 activity, but no matter how high I turned it up, it didn’t go up any levels. If I pressed the sponges against my head, the activity went up. I was confused.

As my fingers ran across the two sponge covers at the same time I realized that they didn’t feel the same. I turned the device off, took out the sponge covers and realized that I had placed one backwards (the sponge was pointing out, with the wire against my head, instead of the sponge being pressed against my head). I corrected this user fail and restarted the device – this time everything worked just dandy.

The device has now finished its first cycle and I don’t feel any noticeable difference, nor did I really feel anything during the entire process. If it wasn’t for the lights on the device, I would have questioned if anything was happening.

So, there ya are. You’ve experienced my first trial with this device. I intend on using it twice a day (once in the morning, once before bed) for the next several weeks and report my findings on a daily basis…but don’t worry, I won’t clog Dave Enjoys up with that, instead I’ll post about it over at OCD Dave. So if you want to read about the ongoing saga you can subscribe to Dave Enjoys using the email subscription box on the right of the OCD Dave blog page or you can use RSS (if you are a geek :)) or you can like the OCD Dave Facebook page and notices of new blog posts will go up there.

Cranial Electrotherapy Stimulation – An Introduction

[NOTE: This post is still in process, but I’ve been fascinated by this treatment methodology, so I’ve done quite a bit more development of it from the original article and while I will continue to revise it, I think it is fairly sufficient. Next step is for me to get my hands on one of these devices and try it for myself…]

Introduction

I’m frustrated. It is 4:05 am and I haven’t been asleep for more than 10-15 minutes at a time yet. Bouts of insomnia like this are an occasional and frustrating occurrence for me. Usually I can’t fall asleep until 6 am – and then what? Sleep through the next day? Gahh!

Image courtesy of OpenClipart.org and laobc.
Image courtesy of OpenClipart.org and laobc.

I decided to Google “what to do the day after insomnia” and came across an ad for a Cranial Electrotherapy Stimulation[1] device. It allegedly works with insomnia, anxiety, depression, pain, etc. Sounds too good to be true right? Yeah, probably, but I figure I’ll do some research and share here what I find out…

Table of Contents

  • Introduction
  • General Claims / Specifications
  • Products / Manufacturers
    • Electromedical Products / Alpha-Stim
    • Fisher Wallace Laboratories / Stimulator
    • Neuro-Fitness / CES Ultra.
    • Other Vendors.
  • Similar / Related Treatments.
  • Recommended Reading.
  • Annotated Bibliography.

General Claims / Specifications

In this section I’ll discuss various claims that are generally made across device manufacturers and then look at some specific claims from various device manufacturers in separate sections below.

  • The devices provide electrical stimulation to the brain in a similar way to Electro Convulsive Therapy (ECT).
  • They are very safe and have been in use since the 1960’s.[2]
  • They are much more cost effective over time than antidepressant medications.
  • Rare side effects are headache, dizzines, skin irritation.
  • CES has never been documented causing a seizure.

Products / Manufacturers

Below you’ll find a list of products/manufacturers. The three main manufacturers appear to be Electromedical Products with Alpha-Stim, Fisher Wallace Laboratories with their Stimulator, and Neuro-Fitness’ CES Ultra. Other vendors – still present or defunct are listed below these companies.

Electromedical Products: Alpha-Stim

  • Product introduced to the market in 1981.
  • Company founded by Dr. Daniel L. Kirsch.
  • Warranty: 5 Year Manufacturers Warranty.
  • Current: 0-600 mA.
  • Frequency: 0.5, 1.5, or 100 Hz w/constant 0.4 Hz.
  • There Alpha-Stim M product is meant to treat pain, anxiety, insomnia, and depression – while the AID does not treat pain.
  • Largest customers are the Department of Defense and Veterans Affairs.
  • Advocates: Dr. Daniel L. Kirsch (President, American Institute of Stress)[3], Dr. Brian Earthman, Dr. Larry R. Price, Dr. Jeffrey A. Marksberry, Dr. William Wong, Dr. Regina McGlothlin, Dr. Norman L. Dykes, Dr. Harry Nakata, Dr. Richard H. Cox (Research Consultant, Duke University Medical Center; Associate Fellow, Georgetown University Medical Center), Dr. Margaret M. Waddington (neurologist), Dr. David J. Fair (Chaplain),

Fisher Wallace Laboratories: Fisher Wallace Stimulator

  • Price: $495-$715.
  • Returns: 60 Days (claim less than 10% return devices).
  • Warranty: 5 Year Manufacturers Warranty.
  • Can be used safely with any medication.
  • Functions by stimulating the brain’s production of neurotransmitters (e.g. serotonin, beta-endorphin).
  • Usually used 2x daily for twenty minutes.
  • Symptom reduction occurs within 1-4 weeks.
  • Based on acquired technology from Dr. Saul Liss, formerly known as “Liss Cranial Stimulator.”
  • Offers the contact info. for a “licensed healthcare practitioner” who will provide “over-the-phone” authorization to appropriate individuals for $50.
  • Advocates: Dr. Richard Brown (Professor of Psychiatry, Columbia University Medical Center), Dr. Andres San Martin (Professor of Psychiatry, Columbia University Medical Center), Dr. Karen Hopenwasser (Clinical Associate Professor of Psychiatry, Weill Cornell College of Medicine), Dr. Paul Fauteck (Psy.D.), Dr. Robert Cancro (Professor/Chairman, Department of Psychiatry, New York University School of Medicine)[4], Dr. Stephen N. Xenakis, Dr. Ronald Podell, Dr. Kelly Brogan, Dr. Lauri Liskin (Clinical Assistan Professor of Psychiatry, Weill Cornell College of Medicine), Dr. Bruce Johnson (Staff Psychiatrist, Crozer Medical Center), Dr. Stephen J. Press, Dr. Sandlin Lowe (Faculty, New York University School of Medicine).

Neuro-Fitness: CES Ultra

  • Price: $349.
  • Returns: 30 Days Unconditional Money Back Guarantee.
  • Warranty: 1 Year Parts/Labor.
  • Advocates: Dr. Charles McCusker, Dr. Eric Braverman (Director, PATH Medical), Dr. Jonathan Douglas.

Other Vendors

The three vendors above appear to be the main competitors in this market. The companies below did / do sell CES devices, but when we are talking about electrifying one’s brain, I’m going to stick with the market leaders – especially when most of these companies seem to be defunct.

  • Orion Medical Group. Magnetic Black Belt – Couldn’t find much info. on this company.
  • Health Directions. HealthPax – Difficulty finding info. related to this product, though it appears to still be sold. Wondering if it is related to the NutriPax that was scathed by QuackWatch?
  • Neurotone Systems. Neurotone – Not much info. available, found a company called Neurotone, but doesn’t sell CES devices, unsure if related.
  • Kalaco Scientific, Inc. Transcranial Electrotherapy Stimulator-A – Little info. available, it appears a business with this name experienced legal troubles and is probably out of business.

Similar / Related Treatments

  • Transcranial Magnetic Stimulation (TMS).
    • Fisher Wallace suggests that TMS treatments cost around $8k-$12k and aren’t covered by insurance.
    • Fisher Wallace states that TMS has only been cleared by FDA for treating Major Depressive Disorder, while their device is cleared for depression, anxiety, insomnia, and pain.
    • TMS is performed at a doctor’s office with expensive equipment.
  • Electroconvulsive Therapy (ECT).
    • Has a very bad reputation due to its portrayal in movies and its historical abuses within psychiatry.
    • Delivers 800-1000+ mA of electricity, compared to 1-4 mA for Fisher Wallace.
    • Cost is significant, though can be reimbursed (sometimes) by insurance.
  • Transcranial Direct Current Stimulation (tDCS).
    • Approved by FDA for other purposes (“lontophoresis”) not for depression, anxiety, etc.

Recommended Reading

Annotated Bibliography

[Note:¬†I’ve barely touched the available research, Google Scholar is returning 2,190 results relating to the query “cranial electrotherapy stimulation]

  1. [1]Outside the United States it is oftentimes referred to as “electrosleep.” In the past was known by terms including “transcranial electrotherapy (TCET)” and “neuroelectric therapy (NET).”
  2. [2]Alpha-Stim claims “no serious adverse events reported” since launching the product in 1981.
  3. [3]He has numerous other credentials.
  4. [4]Dr. Cancro has numerous other credentials.
  5. [5]I say this very tentatively, I really could be reading these results backwards.

A Summary and Response to Scrupulosity in Patients with OCD published in Journal of Anxiety Disorders

Introduction

Obsessive-Compulsive Disorder (OCD) is a nasty beast. I find the scrupulous (religious) elements the most ugly b/c unlike the general OCD symptoms I have a much harder time distinguishing which are “legitimate” and which are “illegitimate.” That is, my brain is being ridiculous when I feel the need to wash my hands over and over again…I have a much harder time knowing if my brain is being ridiculous when it constantly urges me to spend more time with God.

Person washing his hands
Person washing his hands (Photo credit: Wikipedia)

I already take medication for OCD – and it helps significantly. I don’t wash my hands too much, turn my car around to check if maybe I accidentally ran someone over without noticing, or so on any more (okay, so I do regularly check thoroughly via my mirrors after backing out of my driveway…), but the scrupulous symptoms, while less intense (they nearly crippled me), are still present.

I have spent significant time in counseling and see a Cognitive Behavioral Therapist currently. I’ve read many books and articles on the topic and am oftentimes one folks who are struggling with OCD or scrupulosity will engage in conversation for assistance.

Lately I’ve been feeling the pressure of the scrupulous more thoroughly and have been trying to battle it off. Part of this includes reading about OCD. Learning about OCD helps soothe me and also gives me ideas for new methods of battling my OCD. In this case I read Elizabeth A. Nelson, Jonathan S. Abramowitz, Stephen P. Whiteside, and Brett J. Deacon’s article “Scrupulosity in Patients with Obsessive-Compulsive Disorder: Relationship to Clinical and Cognitive Phenomena.” (Journal of Anxiety Disorders, 2006, pp. 1071-1086).

It is a fairly technical article and I am not trained in statistics and other forms of research analysis, so some portions of the report where undecipherable to me…but I figured I’d share what I was able to distill from the report along with my commentary when I had such.

Summary and Response

  • “The themes of OCD vary widely…with one of the more¬†recalcitrant¬†presentations involving obsessions and compulsions concerned with religion…” – pg. 1072.
    • I’m glad to hear it isn’t just inside my head that scrupulosity is difficult to treat.
  • “Religious OCD symptoms…typically involve ‘seeing sin where there is none’ and are frequently focused on minor details of the person’s religion, to the exclusion of more important areas.” – pg. 1072.
    • I think I am much better at this now than previously, but it is very easy to get tied up in small details and anxiety which prevents one from loving others. The principle that I am to love to the maximum has been helpful to me in setting aside anxiety and being willing to wade into situations where I know I will fail (sin).[1]
  • “Examining the content of obsessions among 425 individuals with OCD, Foa and Kozak (1995) found religion to be the fifth most common theme, with 5.9% of patients endorsing it as a primary obsessional symptom. Antony, Downie, and Swinson (1998) found that 24.2% of a sample of 182 adults and adolescents with OCD reported obsessions having to do with religion (not necessarily their primary obsession).” – pg. 1072.
  • “Previous research suggests that a patient’s religious denomination and strength of religiosity can influence his or her OCD symptoms…and clinical observations indicate that scrupulosity is often inadvertently reinforced by the teachings of the individuals religion.” – pg. 1072.
    • I have found this to be true in my own experience. When I have been in settings which emphasize my part, my symptoms flare up exceedingly whereas settings which emphasize God’s sovereignty and grace oftentimes relieve symptoms.
    • I read grace books on an almost continuous basis (e.g. Rutland, Lucado), as I have a tendency to quickly fall back into performance mode.
  • “Scrupulosity, with a focus on morality, is also mentioned in DSM-IV-TR as a symptom of obsessive-compulsive personality disorder (OCPD). However, whereas the thoughts and doubts pertaining to morality are experienced as unwanted and unwelcome (i.e., ‘ego-dystonic’) in OCD, they are experienced as consistent with the person’s world view (i.e., ‘ego-sytonic’) in OCPD…In contrast, the scrupulous ideation in OCPD (a) does not evoke anxiety or fear, (b) is not subjectively resisted, and (c) is not associated with violent and sexual obsessions.” – pg. 1072.
    • This is a footnote at the bottom of the page, but I disagree with it. I would suggest that individuals with OCPD, at least in my limited experience, may not be internally aware of their distress, but are in fact suffering significant distress. I think I could have been classified at one juncture as OCPD but at some definite point in time (during my college years) I experienced a ‘breakthrough’ which provided insight into the underlying anxiety and control, allowing me to become ‘OCD’ rather than ‘OCPD.’ The older one becomes with OCPD, the less possible I imagine it is to transition into OCD, b/c it involves admitting that much of what one has done and said over the last x number of years was of no or negative consequence. I was young and did not have much to look back on and admit was a wash.
  • “Contemporary cognitive-behavioral models of OCD implicate specific¬†cognitive phenomena in the development and maintenance of the disorder.¬†These cognitions include: (a) overestimation of threat (the belief that negative¬†events are especially likely and would be especially awful); (b) inflated¬†responsibility (the belief that one has the power to cause, and/or the duty to¬†prevent, negative outcomes); (c) overimportance of intrusive thoughts (the belief¬†that the mere presence of a thought indicates that the thought is significant); (d)¬†the need to control intrusive thoughts (the belief that complete control over one‚Äôs¬†mental processes is both necessary and possible); (e) perfectionism (the belief that¬†mistakes and imperfection are intolerable); and (f) intolerance of uncertainty (the¬†idea that it is important to be 100% certain that negative outcomes will not occur¬†(Frost & Steketee, 2002).” – pg. 1073.
  • ”¬†The essential tenet of cognitive-behavioral models…is that OCD develops when unpleasant, yet¬†harmless, intrusive thoughts, doubts, impulses, and images are misinterpreted¬†along the lines of the cognitive factors described above. This misappraisal evokes¬†anxiety and motivates efforts to reduce this anxiety via neutralizing behavior (e.g.,¬†rituals) which is reinforced by the immediate (albeit temporary) reduction in¬†distress it engenders…” – pg. 1073.
  • They used a number of different tools to analyze symptom severity, etc. Some I was familiar with, some I’d like to look into further. These included the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Obsessive-Compulsive Inventory Revised (OCI-R), Beck Depression Inventory (BDI), State-Trait Anxiety Inventory-Trait version, Form Y (STAI-T), Penn Inventory of Scrupulosity (PIOS), Interpretation of Intrusions Inventory (III), Intolerance of Uncertainty Scale (IUS), and Mini International Neuropsychiatric Interview (MINI).
  • “Post hoc comparisons…revealed that Protestant patients…scored significantly higher on the PIOS than did patients with no religious affiliation…but not significantly higher…than did Catholic patients…” – pg. 1079.
  • “When we computed similar correlations for Catholic and Protestant patients separately, we found no significant relationships between PIOS score and strength of religious devotion in either of these groups.” – pg. 1079.
    • Essentially, one’s religious fervency is not correlated with the intensity of the symptoms, if I am understanding this correctly. Thus an individual barely committed to Christianity and an individual with a strong, life-long commitment may experience similar symptoms with similar severity. I would consider this a significant indicator for underlying biological/chemical/neurological processes (something which isn’t at issue here, but which is still a topic of discussion within Christian counseling circles).
  • “As expected, the¬†OCI-R obsessing subscale significantly predicted scores on the PIOS.” – pg. 1080.
    • If I understand this correctly, one can predict scores regarding scrupulosity significantly using a more general OCD inventory that evaluates the obsessive nature of an individuals OCD.”
  • “Our data¬†indicate that scrupulosity symptoms are present in each presentation of OCD.¬†Although, as expected, patients suffering primarily with severe unacceptable¬†obsessional thoughts (i.e., religious, violent, and sexual obsessions) evidenced¬†greater levels of scrupulosity compared to those with primary contamination¬†symptoms.” – ¬†pg. 1081.
    • I’d like some clarification on the first sentence above. Are the authors saying that every individual with OCD has some scrupulosity or that for each type of OCD symptoms (e.g. hand washing versus counting) there are examples of individuals with scrupulous behavior – I tend to think the latter.
  • “Thus, even if¬†religious obsessions are not associated with especially high frequency,¬†interference in functioning, difficulty with resistance or control (i.e., the¬†symptom parameters assessed by the Y-BOCS), these phenomena might¬†represent a particularly distressing presentation of OCD.” – pg. 1082.
    • If I’m understanding this correctly, the frequency with which obsessions occur are not more with scrupulosity than seen in OCD generally, but they can be much more distressing to the sufferer than general OCD. I would agree with this.
  • “In support of our second hypothesis, scrupulosity was moderately associated¬†with multiple cognitive biases believed to underlie the development of¬†obsessional symptoms, including moral TAF, overestimates of the importance¬†of and need to control intrusive thoughts, and inflated perceptions of¬†responsibility.” – pg. 1082.
    • In other words, scrupulous sufferers are more likely to have poor cognitive patterns regarding the reality of their responsibility for their thoughts but they do not suffer (more frequently) poor cognitive patterns regarding the power of their thoughts to injure others.
  • “In an effort to reduce obsessional distress, individuals engage in compulsive (neutralizing) behaviors such as excessive¬†prayer, confession, and checking for reassurance from religious authorities,¬†among other strategies.” – pg. 1083.
  • “Research indicates that exposure and response prevention (ERP) is the most effective treatment for OCD (Kozak & Coles, 2005a), although many OCD patients with scrupulosity have difficulty accepting and adhering to ERP because it involves directly confronting situations and thoughts that are perceived to be sinful.” – pg. 1083.
    • Yup, that is a real problem…
  • “Nevertheless, we speculate that some CT techniques have relevance for facilitating ERP in cases of scrupulosity. For¬†instance, patients could be taught that everyone sometimes experiences unwanted (morally repugnant) thoughts. The therapist could also arrange a meeting between the patient and a clergy member to disconfirm the idea that the occurrence of intrusive and unwanted thoughts (as opposed to deliberately thinking such thoughts) is equivalent to committing sinful behavior.” – pg. 1083-4.
    • I’d agree with this. Normalizing intrusive thoughts is important and helping an individual understand the difference between undesired and intentional immoral thoughts is also important.
    • I think that these unwanted thoughts are still ‘sin’ – but I would suggest that they are outside the control of the individual within this lifetime. An emphasis should be placed on the generosity of God’s grace and the petty God one creates when beating oneself up for unwanted thoughts.
  • The authors seem to suggest that ERP is still a way forward, once cognitive training has occurred (pg. 1084). I agree that ERP is an option, but I’m concerned about whether there is enough of an understanding of the importance of not overriding the morals of the individual in an attempt to cure – e.g. showing an individual who struggles with impure sexual thoughts pornography. This is an unacceptable solution within the faith community. We need another way forward…and energies placed into ERP that requires an individual to compromise on legitimate moral beliefs will not be that way.

Concluding Thoughts

I’m thankful to Nelson, Abramowitz, Whiteside, and Deacon for their careful research on scrupulosity. I applaud their commitment and dedication.

I’m thinking about (and hoping others suffering scrupulosity will do the same) what sort of therapeutic process could be utilized to treat scrupulosity that would not involve ERP procedures that would encourage actions considered immoral by the faith community.[2]

A few ways in which I have attempted to battle scrupulosity without engaging in this form of ERP therapy is:

  • Looking for my “secular” OCD and battling that. e.g., focusing on my vocal ticks (still have ’em), checking doors, and looking for people I ran over. Since they are all driven by the same underlying brain processes, I figure working on one should help relieve others…
  • Reading constantly a diet of materials which counter my brain’s natural ways of thinking and which encourage me to understand God as bigger and more important than me – items which while affirmed by the scrupulous oftentimes fail to take root in our hearts (at least in mine).
  1. [1]I can be quite a good person by myself, but being around human beings is difficult. :) At times I would isolate myself to avoid sinning.
  2. [2]In other words, even if the individual accepts the procedures as necessary, I think this is not a road forward, as the larger faith community cannot approve of these measures.