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The '''Gupta Program''' or '''Gupta Programme''' or '''Amydala and Insula Retraining''' describes itself as "[[brain training|brain retraining]]" techniques designed "to alter [[amygdala]] and [[insula]] activity" in order to treat or cure [[chronic illness|chronic diseases]] including [[chronic fatigue syndrome]] and [[fibromyalgia]].<ref name="Gupta2002" /><ref name="MAIR2020" /><ref name="ASA2018">{{Cite web | url=https://www.asa.org.uk/rulings/harley-street-solutions-ltd-a17-400324.html | title = Harley Street Solutions Ltd | last = Advertising Standards Authority {{!}} Committee of Advertising Practice | authorlink = Advertising Standards Authority | first = |website=Advertising Standards Authority | date = April 11, 2018|access-date=2020-08-29}}</ref> The Gupta program is based on the [[amygdala hypothesis]] of [[chronic fatigue syndrome]], which is not [[peer review]]ed, is unproven, and has not been a focus of research.<ref name="Gupta2002" /><ref name="MAIR2020" /> In 2018, the Gupta Program was found to be making unproven advertising claims including wrongly claiming that it can be used to treat [[fibromyalgia]], [[Electrohypersensitivity|electrical sensitivities]] as well as [[ME/CFS]].<ref name="ASA2018" /> The UK's [[ME Association]] charity refuses to accept adverts for the Gupta Program, and does not endorse it.<ref name="MEA-ads">{{Cite web | last = ME Association | first = | authorlink = ME Association | date = Sep 19, 2012 | website = [[ME Association]]|archive-url=|archive-date=|url-status=| url = https://meassociation.org.uk/2012/09/new-advertising-feature-started-on-mea-website-19-september-2012/ | title = New advertising feature started on MEA website {{!}} 19 September 2012|access-date=2022-06-03|quote=We respectfully decline any contact from practitioners offering the Lightning Process, Gupta Programme, Mickel Therapy, or any similar training courses.}}</ref><ref name="MEA-CAM">{{Cite web | date = May 30, 2015 | website = [[ME Association]]|archive-url=|archive-date=|url-status=| url = https://meassociation.org.uk/wp-content/uploads/Alt-comp-approaches.pdf | title = Alternative and complementary approaches to management | first = Charles | last = Shepherd | authorlink=Charles Shepherd|access-date=2022-06-03|quote=Publicity for these approaches often includes glowing reports from people who have gained benefit – some of whom then go on to become therapists. However, none of these approaches has so far been subjected to proper clinical trials to assess their efficacy and safety. The MEA does not therefore endorse or recommend any of these treatments.}}</ref> ===Alternative names=== Other names used for the Gupta Program include: * Amygdala Retraining Techniques (ART) * Amygdala Retraining Program (ARP)<ref name="Conf2016">{{Cite web | url=https://growthzonesitesprod.azureedge.net/wp-content/uploads/sites/1869/2020/10/IACFSME-2016-Program.pdf | publisher=IACFS/ME | title = 12th Biennial Conference Syllabus | date = October 2016}}</ref> * Amygdala and Insula Retraining (AIR) * Gupta Amygdala Retraining<ref name="ASA2018" /> * Gupta Programme<ref name="ASA2018" /> The randomized controlled trial of "Mindfulness-Based Program Plus Amygdala and Insula Retraining" (MAIR) involved using part of the Gupta Program but delivered face to face by a qualified psychologist and includes additional [[mindfulness]] for stress, plus "treatment as usual" (for example medication), and the trial cannot show evidence of the effectiveness for the Gupta Program.<ref name="MAIR2020" /> == Theory == The hypothesis behind the Gupta Program was published in 2002 and describes a theory involving amygdala overactivation, the hypothesis and treatment were later updated to describe [[insula]] involvement, neither version has been [[peer review]]ed.<ref name="MAIR2020" /> The new hypothesis is described on the Gupta Program website but is not published or peer-reviewed research.<ref name="website">{{Cite web | last = Gupta | first = Ashok | authorlink = Ashok Gupta | date = | title = Gupta Program {{!}} The Secret of Amygdala Retraining | url = https://www.guptaprogram.com/|website=The Gupta Program|access-date=2022-06-04|quote=}}</ref><ref name="Medical3Pager">{{Cite web | last = Gupta | first = Ashok | authorlink = Ashok Gupta | date = Feb 2021 | title = Medical Pager Final Version | url =https://guptaprog.b-cdn.net/wp-content/uploads/2021/02/Gupta-Program-Medical-Pager-Final-Version.pdf | website=The Gupta Program|access-date=2022-06-04|quote=}}</ref> Well-known patients [[Jennifer Brea]] and Ana Harris have criticized the Gupta Program's assumption that symptoms were caused by an overactivation/reactivity in the brain that was claimed to be unrelated to the underlying illness, an assumption which is presented as an uncontested fact by the Gupta Program.<ref name="JenTweets" /><ref name="Harris2018" /> This belief of "symptoms without disease" and the assumption that flawed [[illness beliefs]] exist that should be challenged are core parts of the [[The 3Ps model|cognitive behavioral model]] of ME/CFS and an hypothesis underlying the use of [[graded exercise therapy]] and the psychosomatic approach to [[Medically unexplained physical symptoms|medically unexplained symptoms]], treatments associated with significant rates of harm.<ref name="Nodecisions">{{Cite web | url=http://www.meassociation.org.uk/wp-content/uploads/2015-ME-Association-Illness-Management-Report-No-decisions-about-me-without-me-30.05.15.pdf | title=ME/CFS Illness Management Survey Results - "No decisions about me without me" Part 1 | last = ME Association | first = | authorlink = ME Association | date = May 30, 2015 | website = [[ME Association]]|archive-url=|archive-date=|url-status=|access-date=}}</ref><ref name="OxfordBrookesSurvey">{{Cite web | url = https://www.meassociation.org.uk/wp-content/uploads/NICE-Patient-Survey-Outcomes-CBT-and-GET-Final-Consolidated-Report-03.04.19.pdf | title =Evaluation of a survey exploring the experiences of adults and children with ME/CFS who have participated in CBT and GET interventional programmes. FINAL REPORT | last = Oxford Clinical Allied Technology and Trials Services Unit (OxCATTS)|location=Oxford Brookes University | date = Feb 27, 2019}}</ref><ref name="TimeToDeliver">{{Cite web | url=https://www.actionforme.org.uk/uploads/pdfs/me-time-to-deliver-survey-report.pdf | date = 2014| title = Time to deliver: initial findings of Action for ME's 2014 survey | last = Action for ME | authorlink = Action for ME |access-date=Jul 1, 2016}}</ref><ref>{{Cite web | quote =CBT/GET have been proven to be based on non-science for ME and should be removed from any recommendations in the guideline.| url = http://www.investinme.org/IIMER-Newslet-17-07-04.shtml | title = Response to NICE 10 year surveillance (2017) – Chronic fatigue syndrome/myalgic encephalomyelitis | last = Invest in ME Research | first = | authorlink = Invest in ME Research | date = Jul 2, 2017 | website = [[Invest in ME Research]]|archive-url=|archive-date=|url-status=|access-date=2019-07-02}}</ref> This "not a disease" theory provides justification for the Gupta Program teaching patients to ignore or minimize their symptoms―despite significant the evidence that ME/CFS has an underlying disease process, and the [[ICD-11|World Health Organization's ICD-11]] manual classes it as a neurological disease rather than a set of symptoms that may not indicate disease.<ref name="icd10">{{Cite web | url=https://icd.who.int/browse10/2016/en#/G93 | title = ICD-10 Version:2016 | last = World Health Organization | first = | authorlink = World Health Organization | date = |website=World Health Organization|archive-url=|archive-date=|url-status=|access-date=2020-09-25}}</ref> Ignoring or minimizing symptoms is inconsistent with [[pacing]], which involves monitoring symptoms and using them to help decide when best to stop an activity in order to avoid a "crash".<ref name="Goudsmit-pacingbasics">{{Cite journal|quote=Although a gradual increase in activity levels is permitted, the rule is that they should stop when the initial mild fatigue turns into a more unpleasant sensation, or where arms or legs begin to feel weak. Most patients will experience these symptoms fairly quickly after commencing an activity, but it is not unusual for some reactions to be delayed. Depending on where they are and what kind of activity triggered the symptoms, the patient may choose to respond either by resting, or if the fatigue is localised, by switching to an activity which uses a different muscle group. | last = Goudsmit | first = EM | authorlink = Ellen Goudsmit | last2 =Howes | first2 = S | authorlink2 = Sandra Howes| url = http://www.axfordsabode.org.uk/me/pacing.htm | title = Pacing: a strategy to improve energy management in chronic fatigue syndrome|journal=Health Psychol Update | date = 2008|volume=17 | pages = 46–52}}</ref> ==Evidence == Evidence is largely limited to patient self-reports. The UK's [[Advertising Standards Authority]] upheld a complaint in 2018 claiming that the Gupta Program being falsely advertised as a treatment for [[chronic fatigue syndrome]]/[[myalgic encephalomyelitis|ME]], [[fibromyalgia]] and "electrical sensitivities" due to the lack of scientific evidence supporting this claim.<ref name="ASA2018" /> ===Amygdala and insula activity hypothesis === There is no scientific evidence to support the Gupta Program claims that chronic diseases including ME/CFS and Fibromyalgia are caused by problematic or dysfunctional patterns or activity in the [[amygdala]] and [[insula]] parts of the brain.<ref name="CDC-causes">{{Cite web | url=https://www.cdc.gov/me-cfs/about/possible-causes.html | title = Possible Causes {{!}} Information for Healthcare Providers {{!}} Myalgic Encephalomyelitis/Chronic Fatigue Syndrome ME/CFS | last = Centers for Disease Control and Prevention | first = | authorlink = Centers for Disease Control and Prevention | date = 2018 | website = CDC|language=en-us|archive-url=|archive-date=|url-status=|access-date=2022-06-01}}</ref> These areas of the brain are not one of the key areas of medical research for ME/CFS, and the UK's patient-driven ME/CFS Priority Setting Partnership did not highlight these within the top 10 it even top 18 areas that medical research should focus on.<ref name="PSP-top10">{{Cite web | access-date=2022-06-01 | date =2022 | title = The Top 10+ ME/CFS research priorities are here!| url = https://psp-me.co.uk/|website=[[Priority Setting Partnership]]}}</ref> ===Amygdala and insula activity changes === There is no evidence that the Gupta Program alters amygdala or insula activity in a positive way-as it claims to do-or even that amygdala or insula activity patterns are altered in ''any'' way. ===Evidence from coaches === The Gupta Program is delivered by "retrainers" (coaches) who charge their clients for coaching them on the program, many of the personal testimonials are offered by coaches who are not neutral since they are earning money by offering the courses and will state have improved themselves as a result of doing the Gupta Program. These personal accounts are not backed up by science and do not include evidence that the coach was even diagnosed with the illnesses claimed, nor that they have actually recovered.{{citation needed | date = 2022}} ==Safety concerns raised by clinicians == The ''Alternative and complementary approaches to management'' by the UK's [[ME Association]] charity for ME/CFS states that "talking treatments" which typically " combine elements of [[Brain retraining|'brain reprogramming']], [[cognitive behavioral therapy|cognitive behavior therapy]], [[neurolinguistic programming|neuro-linguistic programming]], and positive thinking" - such as the Gupta Program - are approaches have not so far "been subjected to proper clinical trials to assess their efficacy and safety" and as a result the ME Association does not therefore endorse or recommend them.<ref name="MEA-CAM" /> ==Reported harms from patients == Some people have reported being harmed by brain training programmes, including [[Jen Brea]], who developed ME/CFS after a virus and has [[Mold illness|mold-related illness]] and [[mast cell activation syndrome]], and Ana Harris, who had mold-related illness.<ref name="JenTweets">{{Cite tweet | date = 2018-02-08|user=jenbrea | title = I crashed really hard from doing Gupta and put it aside because I didn't understand the theory. I rarely have negative thoughts about anything, let alone being sick. I do have physical signals that modulate my behaviors and I'm not sure I want to turn them off.| url = https://twitter.com/jenbrea/status/961677015286874112?lang=en}}</ref><ref name="Harris2018">{{Cite web | url=http://anaharriswrites.com/my-brain-retraining-story/ | title = My Brain Retraining Story|website=Ana Harris Writes | date = Sep 11, 2018 | last = Harris | first = Ana|language=en-US|access-date=2020-09-25}}</ref> ==Notable studies == *2020, Mindfulness-Based Program Plus Amygdala and Insula Retraining (MAIR) for the Treatment of Women with Fibro<ref name="MAIR2020">{{Cite journal | title = Mindfulness-Based Program Plus Amygdala and Insula Retraining (MAIR) for the Treatment of Women with Fibromyalgia: A Pilot Randomized Controlled Trial | date = Oct 2020| url = https://www.mdpi.com/2077-0383/9/10/3246/htm|journal=Journal of Clinical Medicine|volume=9|issue=10 | pages = 3246 | last = Sanabria-Mazo | first = Juan P. | authorlink = | last2 = Montero-Marin | first2 = Jesus | authorlink2 = | last3 = Feliu-Soler | first3 = Albert | authorlink3 = | last4 = Gasión | first4 = Virginia | authorlink4 = | last5 = Navarro-Gil | first5 = Mayte | authorlink5 = | last6 = Morillo-Sarto | first6 = Héctor | authorlink6 = | last7 = Colomer-Carbonell | first7 = Ariadna | last8 = Borràs | first8 = Xavier | last9 = Tops | first9 = Mattie | last10 = Luciano | first10 = Juan V. | last11 = García-Campayo | first11 = Javier|language=en|doi=10.3390/jcm9103246|pmc=PMC7599726|pmid=33050630|access-date=|issn=2077-0383|quote=|via=}}</ref> - [https://www.mdpi.com/2077-0383/9/10/3246/htm (Full text)] ::'''Conflict of interest not declared:''' Author and investigator Virginia Gasión (Virginia Gasión Royo) had been a Gupta coach since 2014, which means she earns from people doing the Gupta Program, giving a direct final financial conflict of interest.<ref name="Guptacoaches">{{Cite web | url=https://www.guptaprogram.com/coaches | title = Our Professional Team of Coaches | last = | first = | authorlink = | date = | website = Gupta Program|language=en-US|archive-url=|archive-date=|url-status=|access-date=2022-06-03}}</ref> *2012, A mind-body technique for symptoms related to fibromyalgia and chronic fatigue<ref name="Toussaint2012">{{Cite journal | title = A mind-body technique for symptoms related to fibromyalgia and chronic fatigue | date = Mar 2012| url = https://pubmed.ncbi.nlm.nih.gov/22385563/|journal=Explore (New York, N.Y.)|volume=8|issue=2 | pages = 92–98 | last = Toussaint | first = Loren L. | authorlink = Loren Toussaint | last2 = Whipple | first2 = Mary O. | authorlink2 = | last3 = Abboud | first3 = Lana L. | authorlink3 = | last4 = Vincent | first4 = Ann | authorlink4 = Ann Vincent | last5 = Wahner-Roedler | first5 = Dietlind L.|doi=10.1016/j.explore.2011.12.003|pmc=|pmid=22385563|access-date=|issn=1878-7541|quote=|via=}}</ref> - [https://www.researchgate.net/profile/Loren-Toussaint/publication/229324365_A_Mind-Body_Technique_for_Symptoms_Related_to_Fibromyalgia_and_Chronic_Fatigue/links/59e3bb3f458515393d5b935f/A-Mind-Body-Technique-for-Symptoms-Related-to-Fibromyalgia-and-Chronic-Fatigue.pdf (Full text)] ::The [[Advertising Standards Authority]] rejected this as evidence of effectiveness of the Gupta Program.<ref name="ASA2018" /> ::This was open to patients with [[chronic fatigue syndrome]] but none completed it. Of the 32 patients randomly assigned to Amygdala and Insula Retraining (AIR) plus standard care, 19% (6 patients) dropped out before starting, 19% (6 patients) did not complete baseline measures but did AIR, 41% (13 patients) did AIR but not the follow-up assessments, 22% (7 patients) did AIR and completed follow-up assessments. Twice as many patients completed standard care, including both assessments - 56% (14 out of 25).<ref name="Toussaint2012" /> ===Articles not peer reviewed or from non-academic journals=== *2010, Can amygdala retraining techniques improve the wellbeing of patients with chronic fatigue syndrome? A clinical audit of subjective outcomes in a small sample<ref name="GuptaAudit">{{Cite journal |archive-url = http://web.archive.org/web/20111119095503/http://www.guptaprogramme.com/Amygdala_Retraining_JHH_Sept_2010.pdf |archive-date=2011-11-11 | url = https://www.guptaprogram.com/wp-content/uploads/2019/02/amygdala-retraining-jhh-sept-2010.pdf | last = Gupta | first = A | authorlink = Ashok Gupta | date =September 2010 | title = Can amygdala retraining techniques improve the wellbeing of patients with chronic fatigue syndrome? A clinical audit of subjective outcomes in a small sample. |journal = Journal of Holistic Healthcare |volume= 7 |issue =2 | pages = 12-15 |access-date=2022-06-02}}</ref> - [http://web.archive.org/web/20111119095503/http://www.guptaprogramme.com/Amygdala_Retraining_JHH_Sept_2010.pdf (Full text)] ::The Advertising Standards Authority rejected this as evidence of effectiveness of the Gupta Program.<ref name="ASA2018" /> ::This was not published in an academic journal<ref name="JHH">{{Cite web | url=https://bhma.org/journal-information-for-contributors/ | title = Journal - information for contributors | last = | first = | authorlink = | date = | website = British Holistic Medical Association|archive-url=|archive-date=|url-status=|access-date=2022-06-03}}</ref> *2002, Unconscious amygdalar fear conditioning in a subset of chronic fatigue syndrome patients<ref name="Gupta2002">{{Cite journal | last = Gupta | first = Ashok | authorlink = Ashok Gupta | date = 2002 | title = Unconscious amygdalar fear conditioning in a subset of chronic fatigue syndrome patients| url = https://www.guptaprogram.com/wp-content/uploads/2019/02/cfs-hypothesis-medical-hypotheses-article.pdf | journal=Medical Hypotheses|volume=59|issue=6 | pages = 727–735|quote=|via=}}</ref> - [https://www.guptaprogram.com/wp-content/uploads/2019/02/cfs-hypothesis-medical-hypotheses-article.pdf (Full text)] ::The ''Medical Hypotheses'' journal that published this is reported to be the world's most controversial journal,<ref name="MHcontroversial">{{Cite journal | title = Editor says no to peer review for controversial journal | date = 2010-03-18| url = https://www.nature.com/articles/news.2010.132|journal=Nature | last = Cressey | first = Daniel|language=en|doi=10.1038/news.2010.132|issn=1476-4687}}</ref> and describes itself as publishing hypothesis that are "radical, speculative and non-mainstream scientific ideas" and some "where experimental support is yet fragmentary".<ref name="MH">{{Cite web | url=https://www.elsevier.com/journals/medical-hypotheses/0306-9877/guide-for-authors | title = Guide for authors - Medical Hypotheses - ISSN 0306-9877 | last = | first = | authorlink = | date = | website = Elsevier|language=en|archive-url=|archive-date=|url-status=|access-date=2022-06-03}}</ref><ref name="MH-SS">{{Cite web | url=https://www.sciencedirect.com/journal/medical-hypotheses | title = Medical Hypotheses {{!}} Journal | last = | first = | authorlink = | date = | website = ScienceDirect.com by Elsevier|language=en-us|archive-url=|archive-date=|url-status=|access-date=2022-06-03}}</ref> It is peer-reviewed. ==Personal experiences== * 2009, [http://web.archive.org/web/20090405173658/http://www.phoenix-cfs.org/BlogAmygdalaTraining1.htm Amygdala Training part 1 Blog] - Cort Johnson (archived) * 2012, [https://phoenixrising.me/myalgic-encephalomyelitis-chronic-fatigue-syndrome-mecfs-treatments/mind-body/amygdala-retraining/a-psychotherapist-reviews-ashtok-guptas-amygdala-retraining-program-by-tamara-lewis/ A Psychotherapist Reviews Ashok Gupta’s Amygdala Retraining Program] – Tamara Lewis * 2010, [https://cfs-survivors.org/blog/2010/07/11/just-passed-six-months-on-the-gupta-programme/ Just passed six months on the Gupta programme] - Graham Stoney ==See also == *[[Criticisms of The Gupta Program]] *[[Ashok Gupta]] *[[Brain retraining]] *[[Pseudoscience]] *[[Mindfulness]] ==Learn more == * 2018, [https://www.asa.org.uk/rulings/harley-street-solutions-ltd-a17-400324.html Advertising Standards Association complaint result] * 2009, [https://web.archive.org/web/20210422023328/https://www.prohealth.com/library/qa-session-with-ashok-gupta-developer-of-the-amygdala-retraining-program-for-me-cfs-and-fm-held-july-10-2009-26402 Q&A Session with Ashok Gupta developer of Amygdala Retraining Program for ME/CFS, FM] - ProHealth (archived) ==References == {{Reflist}} [[Category:Psychological paradigm]] [[Category:Psychological and behavioral therapies]] [[Category:Potential treatments]] [[Category:Brain training]]
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