Criticisms of The Gupta Program

The controversial Gupta programme or mindfulness plus amygdala and insula retraining or MAIR is a behavioral self-help therapy.

Introduction
Wide-ranging concerns have been raised about the Gupta programme for conditions that Gupta treats, especially ME/CFS, Fibromyalgia and Long COVID.

There are recent (2021) complaints from the Covid and Long Covid Community in forums concerning the lack of empirical evidence for Gupta’s treatment of Covid and Long Covid; for aggressive, inaccurate and dangerous advertising; and for his method of connecting and gaining endorsement from well-known Covid figures. For example, the new draft NICE guidelines for ME/CFS clearly state NLP should not be offered to patients with ME; Long Covid patients with similar symptoms should not have to suffer the same mistakes.

There are historical and present day controversies in the ME Community from the Gupta programme and other brain retraining organisations: again on misleading and false advertising; patient harm; treating physical problems with psychological methods; and the wider problem of encouraging the belief in “symptoms but no disease”.

This leads into the concern about the Gupta program exclusively treats Medically Unexplained Symptoms (MUS) and conditions with no reliable measurable biomarkers; how is one treatment able to treat such variable and different conditions? Treating physical conditions with cognitive techniques and NLP raises the issue looked at upon in Anthropology – Magical Thinking i.e. how changing our thinking changes our reality and state of disease and the issues that come from this in applying it to medicine, including patient blaming.

The next point deals with Institutional Misogyny and how treating conditions predominantly related to female pain with psychological techniques or explaining their aetiology as emotional is a reinvention of the hysteria paradigm.

Ashok Gupta does not have any medical, scientific, or psychological qualifications – he has an Economics degree from Cambridge University. What are the ethics of charging for an expensive programme where the therapist has no training or qualifications and there is no regulatory body to monitor or protect patients? So there is a combination of no empirical evidence and no relevant qualifications.

Giving psychological care as a primary treatment and offering psychological techniques as a cure has been a battle within the ME community. This is very different to offering it to a patient as a secondary and supportive treatment. Both have very different motivations and teleological aims.

There is also the concern that this is classic pseudoscience – where the treatment offered is dressed up in scientific language and presented as scientific and scientific evidence is given to justify the hypothesis. Yet on closer inspection none of the claims can be backed up as rigorous science and is full of theoretical holes and misperception.

Finally, but most importantly, there is a lack of empirical evidence. The Advertising Standards Agency (ASA), ME Association and others have found that none of the scientific papers presented by Gupta are sufficient evidence that his protocol can treat or cure the conditions he claims to. The authors of the most recent published paper were contacted – they had no idea Gupta was using their paper as proof, they have no connection to him and do not endorse his programme.

Concerns from the Covid and Long Covid community
In March 2020 when the Coronavirus Pandemic began Gupta released a package called the 10 Day Coronavirus Challenge where "Some of the tools in this program have been scientifically shown to reduce the chances of contracting an infection from a virus by over 80%". The tools in his program are meditation, NLP, neural retraining and amygdala calming. A complaint was made to the ASA and they responded to say that there is a previous ruling against the owner or originator of the video and the video seems to fall within the scope of that ruling the case has been passed to the Compliance Team.

There is no evidence that Long Covid is caused by a faulty or overactive amygdala. The cause is exposure to a virus and post viral complications. Calming reprogramming is not the way out. We need proper scientific biochemical research. Long Covid at the moment has no measurable biomarkers (like many of the other conditions Gupta treats) and is open to unethical practitioners trying to treat a little understood syndrome with no empirical evidence.

Concern that Gupta has jumped on the Long Covid Bandwagon by treating a new disease with no evidence that his theory can be transposed onto Long Covid. While the disease mechanism has not been fully understood it will likely be in the near future. It is highly unlikely it is a highly strung amygdala; we know what caused Long Covid: the coronavirus, not stress.

The Gupta Foundation aggressively lobbies Long Covid authorities, e.g. Dr Tamsin Lewis, Dr Tina Peers , Gez Mendinger, who then give publicity to his unproved theory, thereby generating business and income for himself. These affiliations then give him authority by association to pass as an expert in treating Long Covid – without even stepping into a lab or having any medical experience. This leads to exposure to a large audience, many who are vulnerable, have little awareness of the previous controversies associated with the Gupta Program and are desperate to try anything to get better. Without research, training, offering a cure and then charging large sums of money to a community is patient exploitation.

Recent sponsorship of the Treat Long Covid Conference by the Gupta Program has raised concerns in the Long Covid Community that a pseudoscience organisation with a controversial and unproven treatment is being pushed to Long Covid patients.

There is concern that Peers states “I now recommend the Gupta Program to all my patients as I believe that it plays a key role in their recovery.” Recommending All your patients to another expensive program which is unproven for Long Covid is dubious. Long Covid is a complex and has many different symptoms; how would one justify each patient needing the Gupta Program? Dr Peers has been contacted and stated that she has no financial, commercial or business relationship with The Gupta Program. She also commented that she hadn't previously heard anything bad about the program.

There are no NICE (National Institute for Health and Excellence) guidelines for Long Covid, but I think it would be sensible to infer similar guidelines for ME/CFS due to the similar symptoms and the mutual risk of relapse from PEM Post-exertional malaise (PEM). The new draft NICE guidelines for ME/CFS states, “Do not offer people with ME/CFS therapies derived from osteopathy, life coaching or neurolinguistic programming (NLP) for example the Lightening Process.” 1.11.16. The Gupta Program is an NLP based program and is therefore unsuitable to be recommended for ME and Long Covid.

Dr Peers also set up the Long Covid Conference and allowed Gupta to sponsor it - yet Peers was not fully aware of the historical controversies and difficulties created by the Gupta Program in other conditions. Gupta is very charming and comes across as very sincere and his ‘science’ seems convincing if looked on at face value. This association with other leaders in medical fields has happened again and again with Gupta. It is part of his marketing method and establishing himself as an ‘authority’ in that field. As Isabel Carrasco Sáenz notes, this is “Pseudoscience getting mixed up with real science. Very worrying. Gupta is sponsoring this conference. Don't researchers have respect for their own work? How can hours and hours of lab work be at the same level as these 'therapies'?”

Historical and Present-Day Controversy within the ME Community
The Gupta Program uses the deeply controversial Brain Retraining methods that have caused immense problems in the ME Community. This field can also be categorised under the discredited psychological and behavioural therapies and mind-body treatments – none of which have strong empirical evidence. If you are not in this field it is easy to not be directly aware of the hurt, false hope, money lost and patient harm inflicted in patients with ME Others include DNRS – Dynamic Neural Retraining System, the Lightning Process], [[Alex Howard's REACT, and ANS Rewire. Fraudlisting.com have compiled an excellent site to educate people about the issues of this approach.

These methods and paradigms of the Wessely school, PACE trial and the Brain Retraining Methods have prevented serious biochemical medical research into post-viral illness. We need immunologists not psychiatrists. 40 years of institutional abuse have occurred in this field. The underlying disease mechanism is not understood in ME because for decades the Behavioural psychiatrists and psychologists have fought for ME to be only located in their field, which has dominated funding, research, clinical guidelines and medical insurance. The PACE trial is one of the medical scandals equivalent to Andrew Wakefield, MMR and Autism. Patients campaigned for 5 years for the full data to be released and it was found to be substandard with the researchers making up data to fulfil their hypothesis. Bruce Levin, Biostatistician of Columbia calls this "the height of clinical trial amateurism," Ronald Davis of Stanford says, "I’m shocked that the Lancet published it…The PACE study has so many flaws and there are so many questions you’d want to ask about it that I don’t understand how it got through any kind of peer review"; Prof Jonathan Edwards of UCL says it "is an unblinded trial with subjective outcome measures. That makes it a non-starter in the eyes of any physician or clinical pharmacologist familiar with problems of systematic bias in trial execution." “The history of ME remains one of the worst examples of unacknowledged institutional abuse in modern times.” ~ Valerie Eliot Smith 2019

Long Covid and other post viral conditions would be much better understood if these delays had not happened. Advocating psychological methods is part of the problem, not the solution.

The point of this short analysis is to show the extent psychological medicine has dominated post viral conditions. The history of the treatment of ME also shows how "cures" such as the Gupta Program have been allowed to come into existence. The Gupta Method is an extension of this flawed paradigm as it uses psychological methods to treat ME and other conditions including Long Covid.

There has been a worrying trend of psychiatrists and other therapists involved in treating ME who are members of the Wessely school coming over into the field of Long Covid due to similar symptoms. The battle that has occurred within the ME is now being transposed into Long Covid. Established figures in this biopsychosocial school such as Michael Sharpe, Prof Paul Garner, Trudie Chalder , Simon Wessely and Peter White, are all active in the media and trying to reestablish their disproven paradigm for psychological treatments such as CBT and GET for Long Covid. An article by George Monbiot describes how Sharpe accused Monbiot of spreading Long Covid simply by talking about it. Simon Wessely, leader of the Wessley School chaired a recent committee on Long Covid funding; Michael Sharpe is back at Oxford heading the Long Covid Clinic, and press articles are being published by leading figures of the school.

Key advocates against the biopsychosocial model include patient advocate Margaret Williams; Countess of Mar; Dr David Tuller, a Senior Fellow in Public Health in Journalism at the Center of Global Public Health, School of Public Health, University of California, Berkeley; Professor Malcolm Hooper, Professor Emeritus of Medicine Chemistry at the University of Sunderland;Tom Kindlon; Alem Matthees; Dr Sarah Myhill, who set up the Medical Abuse in ME Sufferers (MAIMES) petition  Medical Abuse In ME Sufferers (MAIMES) petition and made a formal complaint to the GMC about the PACE trial; Dr Charles Shepherd, Hon Medical Advisor of the ME Association, who states that “NICE has warned that their current recommendations regarding GET for ME/CFS should not be transferred to people with Long Covid. We hope that this new cohort of post viral patients with Long Covid will not have to suffer the same mistakes that have been inflicted on people with ME/CFS”.

Despite this appearance of open debate, a clear scientific consensus has been reached. The NICE draft guidelines (November 2020) state: “If anyone deserves an apology it is the people with ME/CFS, many of whom have experienced years of being told that their symptoms are “all in the mind” and given no meaningful medical management – mainly as a result /of the dominance of the psychosocial model of causation. As a result, progress involving biomedical research into the underlying cause of ME/CFS has been severely hampered.” The ME Association further clarifies, “The reason why people with ME/CFS feel angry and let down by the medical establishment stems from the fact that almost all biomedical research until recently has been funded by donations to the charity sector. Almost all government funding has gone into research based on a flawed psychosocial model of causation.”.

Vincent Racaniello in his virology blog states, “For months, Professor Sharpe and his colleagues have been deploying the Long Covid phenomenon in a campaign to shore up their cherished but collapsing CBT/GET approach to ME/CFS and related conditions.”

The point here is that it is not just Sharpe and his colleagues it is also the Gupta foundation that is found on the same principles: psychological treatments for a biophysical condition. They are trying to establish themselves in the Long Covid world without justification.

The ME Association in the UK does not recommend that people with ME undergo the Gupta Program. In September 2018 the ME Association took the Gupta Program to court and reported their concerns to the ASA – Advertising Standards Agency. Dr Charles Shepherd wrote:
 * “In relation to the Gupta Programme, this is not a form of treatment that we recommend, and we welcome the fact that the ASA has taken this action in relation to the way it is being advertised to the general public.”

The complaints were:


 * “The complainant challenged whether the claims that the Gupta Programme could treat the following conditions were misleading and could be substantiated:
 * 1.	“Fibromyalgia”;
 * 2.	“Chronic Fatigue Syndrome (CFS) or ME”; and
 * 3.	“Electrical Sensitivities”
 * All three complaints were upheld with the evidence produced by the Gupta Program seen as insufficient. Action:


 * We told Harley Street Solutions Ltd not to state or imply that the Gupta Programme could treat “Fibromyalgia”, “Chronic Fatigue Syndrome (CFS) or ME” or “Electrical Sensitivities”. We told them to ensure that they held substantiation for any similar claims relating to medical conditions or symptoms.


 * Therefore, there should be no advertising or reference on the Gupta Foundation website that this method can treat these conditions. I would infer that other symptoms and medical conditions would include Long Covid.

It is vital to not repeat the mistakes that were made with treating and diagnosing ME in Long Covid. It was through the faulty belief established through Cognitive Behavioral Psychology (Wessely school) that ME was caused by deconditioning and patients had too much fear to be active therefore keeping themselves in a vicious circle, and that ME was a disease of psychiatric origin with the cause also being seen as mass hysteria. This is also known as the biopsychosocial model (BPS). Therefore Graded Exercise Therapy (GET) was prescribed to condition them and make them overcome their fear and psychological therapies were given such as CBT to help them change their negative thought and emotional processes about exercise. While on this programme, physical and diagnostic tests are also to be actively avoided. Receiving benefits or sick pay is also discouraged as this is seen as an obstacle to recovery.

As previously demonstrated, Long Covid is being "psychologised" and treated with exercise therapy or psychological therapy i.e. CBT, NLP, or any of the Brain Retraining techniques such as the Gupta Program. Yet we are seeing an attempt in the press and medical practitioners through research and advocacy to return this paradigm to Long Covid. It is up to patients, researchers, practitioners, doctors and therapists to be vigilant and educated so we actually make breakthroughs in the correct areas such as neurology and immunology and do not waste precious time and money. We can then find therapeutic treatments that actually work and stop the gaslighting of those with postviral disease.

Exclusively Treats MUS (Medically Unexplained Symptoms) and Conditions with No Measurable Biomarkers
It is concerning and suspicious that Gupta only treats MUS (Medical Unexplained Symptoms) and conditions not treated or well understood in mainstream medicine and with no measurable biomarkers– these include ME/CFS, Fibromyalgia, Mold, IBS, MCAS, Chronic Pain Syndrome, Long Covid, Anxiety, Adrenal Fatigue, SIBO, CIRS, Burnout, POTS, Multiple Chemical Sensitivity. Some therapists primarily see these MUS as psychosomatic conditions or manifestations of mental illness. It can also be seen as the height of medical arrogance to assume it is a mental illness because the aetiology has not been found. Where is the evidence that these conditions are all connected and are different manifestations of the same Amygdala and Insula hypothesis? These conditions are often misunderstood and seen as have a psychological origin and not a genuine disease pathway. There is new and promising research that these conditions are often co-morbid with joint hypermobility and Ehlers-Danlos Syndrome ; there is also new research concerning autoantibodies and the immune system, it is not a highly reactive amygdala.

Why does he not treat Cancer, Lupus, MS, Parkinsons? It would be absurd and insulting for patients of these conditions to be only treated and offered cures with brain retraining, CBT, NLP or Neuroplasticity. Why should sufferers of the illnesses Gupta claims to cure have to go through this either?

Just because an underlying disease mechanism has not been found does not mean it does not exist.

False hypothesis of “symptoms without disease”
The Gupta program puts forward a “symptoms without disease” hypothesis: symptoms are caused by an overactive/reactivity in the brain that is unrelated to the original illness which is now gone from the body.

This “symptoms without disease” is an extension of the work of the Wessely school in the field of ME. This school hypothesised that ME was psychiatric in origin and had no disease mechanism in the body. It therefore needed to be treated with CBT, i.e. psychological methods to overcome faulty emotional and mental thinking/processes.

Michael Sharpe claims “it is not a particular biological process, but rather specific psychological and behavioural mechanisms that are the common factors determining the clinical characteristics of the syndrome.”

The Gupta Program employs a similar treatment program to CBT (changing thought processes and calming down the emotional system) although based more on NLP and is framed as neuroplasticity. This is the wrong paradigm to address serious illness and should be challenged. The website clearly states that after the original illness has gone the patient is left with symptoms but no underlying disease mechanism.

Magical Thinking and Patient Blaming
Danger of patient blaming. Brain retraining programs often claim that if you aren’t cured you didn’t try hard enough. It also roots the aetiology of the illness in the false beliefs and emotional trauma or stress of the patient. The Gupta Program involves visualizing yourself well and interrupting thoughts about your illness with hand signals and phrases such as “soften and flow” and “stop, stop, stop”. These are psychological methods to treat a physical illness. It is therefore the efficacy of the patient in carrying out these procedures that determines the cure. So the cause and the cure is down to the emotional and neurological actions of the patient. No one blames an individual for getting cancer or MS or gives them psychological techniques primarily to treat and cure them or blames them for not recovering if they do not rewire their amygdala.

In Anthropology this is termed "magical thinking" and discussed at length by Levi-Strauss. In medicine it is often called ‘mindset medicine’. This is where changing our thinking will change our reality and therefore our illness. This is not a method in modern medicine and is absurd. If this were the case then all illness or difficult situations would easily disappear. This is the stance that the Wessely School took through the treatment of CBT, it is also relevant to the NLP and Brain Retraining of the Gupta Program and the Brain Retraining methods.

Institutional medical misogyny – reinventing the hysteria paradigm
ME, Lyme disease and Long Covid as well as other autoimmune conditions that Gupta claims to treat predominantly effect women. Why this is in medically unknown at the moment although research is starting to be done.

The historical pattern of this paradigm is hysteria. Women’s pain is often more likely to be classified as emotional or psychological in origin and require emotional or psychological treatment. This is investigated in depth in Jackson's Pain and Prejudice: A call to arms for Women and their Bodies and in Medical Historian Elinor Cleghorn's book Unwell Women: Misdiagnosis and Myth in a Man-made world.

Early onset Parkinson's disease in women is still more likely to be classed as ‘emotional’. Multiple sclerosis before the physical disease origin was discovered was also seen as an onset of hysteria.

The medical world does not tend to use the word hysteria now, the terminology has changed to ‘emotional’, ‘psychological’ ‘based in the neurological system, ‘overactive amygdala’, ‘sympathetic nervous system arousal’, or ‘stress’.

Any treatment program, like the Gupta Program, that uses calming methods is propitiating the hysteria program by essentially saying that if we calm down, we will be cured. The illness is caused by faulty emotional and mental processing based in the nervous system (previously called hysteria) that through calming will go away. Essentially the Gupta Program is a heavily disguised hysteria paradigm that is repackaged in the language of neuroscience.

Lack of training and expertise
Treating, charging and offering cures with no medical training or regulation.

Psychological primary treatment and not secondary and supportive
In a better world, supportive counseling, mindfulness and stress management should be given to those with chronic illness – this can be very helpful. Stress undoubtably can cause physical symptoms in the body. Yet this is very different to saying that stress, trauma or faulty emotional and mental patterns are the aetiology of a disease and the underlying disease mechanism and therefore the patient needs mindfulness-based techniques and a change in thought processes to be cured. You can not imagine that a cancer patient or Muscular Dystrophy patient to be only offered psychological cures. This is what has happened to ME patients for decades. This is also the basis of the therapies offered in the Gupta Program such as visualising yourself better, repeating phrases such as “soften and flow” and interrupting thoughts about your illness with gestures and phrases such as “stop stop stop” and other CBT methods of thought stopping. There are no diagnostic testing or physical interventions.

Classic pseudoscience
The Gupta Program is pseudoscience as it asserts itself to be scientific; its allegedly established facts are presented as justified true beliefs and it asserts that its 'established facts' have been justified by genuine, rigorous, scientific method. Other concerns are that it uses obscurantist language, and technical jargon in an effort to give claims the superficial authority of science. All of the Brain Retraining methods piggyback on the newly emerging field of Neuroplasticity and draw on the authority of Neuroscience terminology. All of this is unproven.

Lack of empirical evidence
Within pseudoscience there is often scientific evidence to validate the given theories but in reality this is not rigorous and sufficient evidence it just sounds good. We find this with the Gupta Process yet there is often a lack of scientific or philosophical training within the community to understand whether the evidence is conclusive and justified. It also gives cause and strength to the wishful thinking of those that want it to work. So let us examine the scientific proofs given by Gupta and their criticisms.

in 2018, the Advertising Standards Agency (ASA) investigated the claims and evidence presented by the Gupta program. When asked for a response the Amygdala Retraining/Harley St Solutions claimed they had conducted clinical trials on their protocol and it could substantiate it could be used to support CFS/ME and Fibromyalgia. They produced two published studies and a draft manuscript for the third study.

The first study was on fibromyalgia and CFS and was peer reviewed in a journal focused on complimentary medicine. It was a single-blinded study and compared the efficacy of amygdala retraining alongside ‘standard care’ – which was a 1.5 day course in CBT and GET. Over half did not complete the study so out of the total 44 participants only 21 completed it, and only 7 from the amygdala retraining group did. This shows significant limitations with such a small case study. The ASA concluded that the study did not substantiate claims the amygdala retraining could treat Fibromyalgia or CFS.

The second study was for CFS only and was an internal clinical audit. It was published in a peer reviewed journal focused on complimentary medicine. As a clinical audit it was not controlled, randomised or blinded. It was authored by the Director of Harley St Solutions (Ashok Gupta) who described the outcome of a one year program, 27 people completed the course. Again, we have a very small case study, researcher bias, and those who had invested financially in a program who were also biased. The ASA stated that due to the limitation of an internal clinical audit the claims that the Amygdala Retraining process could not be substantiated.

The draft manuscript was from a Spanish randomised controlled trial which wasn’t published so it was not subject to peer review. The treatment delivery did not replicate the method of the Amgydala retraining course advertised. There were 64 participants, 22 in the relevant group and only 19 completed the study. Again this is a small sample size and it was not able to control for the possible influences of the individual therapist in each group. Again the ASA ruled that the trial did not substantiate claims made by Harley St Solutions.

The study in September 2010 in the Journal of Holistic Healthcare is not a high enough quality treatment trial, there was no randomisation, no control group, no controlling for other treatments or blinding to prevent researcher and sample bias.

The Gupta Program is claiming to be backed by scientific studies but under closer examination the studies were not found be sufficient enough be used as evidence. This is very concerning for the general public who may not have a science background and are being fooled into thinking what they are doing has genuine empirical evidence behind them. It is telling that the program thinks that it can bring forward and back its claims with scientific evidence where anyone with any scientific training would know that these studies are not sufficient in the least. Combined with the claims that the Gupta Program could reduce your chance of catching the coronavirus by 80% I would conclude that Ashok Gupta is not a reliable source of information or evidence for his own program.

In 2020 Gupta published an article on his website “New Study Shows Neuroplasticity ‘Brain Retraining’ program is an Effective Treatment for Fibromyalgia”. But on examination we find that this is the same study that was presented to the ASA as evidence. There was a draft manuscript that hadn’t been published and is the Spanish study. The ASA concluded that the study did not replicate the method of the Gupta Program; it was a small case study – 19 completed the study; and it did not control for the possible influences of the individual therapist in each group. The ASA have said that this paper does not give enough evidence to claim to treat or cure Fibromyalagia.

The study "Mindfulness-Based Program Plus Amygdala and Insula Retraining (MAIR) for the Treatment of Women with Fibromyalgia: A Pilot Randomised Controlled Trial" in the Journal of Clinical Medicine. I would begin with saying the sample size of 19 is far too small to make claims that GP is an effective treatment for Fibromyalgia. The patients also continued to take their normal drug routine so we do not know if over this period they showed improvement from their other medical treatments. One of the major issues though is that we have two psychological treatments bundled together, mindfulness and Amygdala and Insula Retraining. This means we cannot know which is causing the effect. “Patients completed some practices included in the mindfulness-based stress reduction (MBSR) program that were added to the amygdala and insula retraining techniques (AIR)”. Gupta's method is based on Amygdala retraining this is the basis of his hypothesis and ‘cure’. If the study had just been done with Amygdala and Insula Retraining then it would give us a clear indication. This is a logical fallacy: A+B→C, therefore A→C. The researchers of the paper were contacted and had no knowledge of the Gupta Foundation claiming that their paper gave credence to the Gupta Program. Dr Juan Luciano, lead researcher of the paper, replied:

“I am really sorry to read this. We had no idea that Mr. Gupta was using our study for commercial purposes. On behalf of my colleagues, I can only assert that there is no personal relationship with Dr. Gupta nor commercial or financial interests with his program. That said, it's really difficult to force him to retract. In my opinion, any legal intervention against Mr. Gupta is in the hands of the UK authorities. We are only academics/researchers attempting to provide the best empirical evidence of available treatments for fibromyalgia, CFS and other central sensitivity syndromes.”

Ashok Gupta claimed it is "our study" “Our Ground-Breaking Study on the Gupta Program Published In The Prestigious Journal of Clinical Medicine. Giving Hope To Millions of Fibromyalgia Sufferers, as the First Randomized Controlled Trial Ever Published on a Neuroplasticity Program!”. It is clear from Dr Luciano that the study is not based on the Gupta Program or has any connection to the organisation.
 * What is the study actually reporting? It says that 2 psychological techniques have been shown to improve psychological factors such as anxiety and mindfulness after 3 months. “The positive effects of MAIR were also observed in a wide range of clinical measures and salutary cognitive variables such as mindfulness, psychological flexibility and self-compassion.” I would suggest that including mindfulness with AIR would likely increase mindfulness we do not have any clarity on whether AIR does. What is very clear is that it does not include clinical factors such as ‘clinical severity’ and ‘health-related quality of life’.

The paper itself states that “Significant decreases in pain catastrophizing and psychological inflexibility and improvements in clinical severity and health-related quality of life were found at follow-up, but not at post-treatment.” Therefore, it does not reduce pain and it does not offer a cure for the underlying disease mechanism. “There were no significant differences between the groups in hs-CRP, TNF-α, IL-6, and IL-10 at post-treatment”. “However, no significant effect of MAIR on cytokine and hs-CRP levels was detected”. It might make you feel better about yourself and your illness, but it is not clear which psychological technique causes this change. Whether Gupta has any formal training in mindfulness in a spiritual or secular form is not made clear – no qualifications are given. I would suggest that charging patients and teaching them mindfulness without any qualification is unethical and possibly dangerous.

The study was for 8 weeks and Gupta claims on his website “so we expect even better results when used for a longer period”, but there is no proof of this. This is actually a problem of replication as the study was not under the same conditions as the Gupta Program and other factors and conditions of the experiment might affect the results.

We also have the very relevant issues of trying to treat illnesses such as ME or Fibromyalgia with psychological methods and treating women with pain issues with only emotional and psychological techniques is troubling. Funding and focus into actual biomedical research would be healthier and prevent the long-standing issues with this tendency. Seeing the large scale failure of the PACE trial I would be hesitant to repeat any such medical abuse with the sufferers of fibromyalgia. There is a case for psychiatrists and psychologists to stay away from the medical fields such as ME, Long Covid, Fibromyalgia if they are offering cures after the damage done to previous patients. Just because a condition is not understood doesn’t mean it needs to be treated with emotional methods. What is needed is better research from Immunologists, Virologists and other medical fields that might be able to shed a light on the understanding mechanism.

There is also self-reporting which is problematic and that the nature of the study is psychological. We do not know how open the participants were to researcher bias or bias to report improvement because they were taking part in a study. Measuring psychological factors is by its nature subjective and we have no empirical, measurable data available from this study.

There is great excitement on the Gupta website about the decreased levels of BDNF in the MAIR group. Yet remember again we are dealing with a very small sample size and the paper states that “However, divergent results have been obtained regarding the role of BDNF in FM, with, Studies finding a lack of association between BDNF and patients’ clinical complaints or finding comparable levels between FM and healthy subjects”

“It is also worth mentioning that low serum levels of BDNF have been found to be a characteristic of depression; in this regard, one could expect that after an intervention with a positive effect on depressive symptoms (as it was the case of MAIR), increases in BDNF levels should be observed. However, we did not find such increases as a significant decrease in the levels of this biomarker was found after MAIR. Our findings may be partially explained by the fact that the study sample showed mild depressive symptoms at baseline (with mean depression scores based on HADS around the minimum cut-off point for caseness of 8 points), thus patients having a major depressive disorder should be a minority in our study.”

Therefore there is no clinical clarity of what this means for the reduction of BNDF. The blood samples were also taken after a period of night fasting from 8 – 8.30. Intermittent fasting which is relevant from not eating from 12 hours effects the BDNF levels. Although this was done to limit the circadian variability of immunological markers its impact on BNDF is not mentioned.

The study also presents some of its limitations:
 * “ small to generate strong conclusions.”
 * “ the possible influences of therapist variables were not controlled, making it impossible to recognize their effect on treatment”
 * “the intervention was not compared with other psychological treatments that have demonstrated effectiveness for FM (e.g., CBT or acceptance and commitment therapy (ACT)) or with aninactive control group alone”
 * “the treatment components (mindfulness and amygdala and insula retraining) were not evaluated independently, and therefore their specific effects with respect to the combination could not be compared”
 * ”it was not possible to follow-up the levels of the biomarkers.”
 * “exploratory and preliminary in nature”

Other key questions are is the study replicable and open to falsification?

The concern is that on the Gupta Foundation Website this published study is everywhere and it clearly does not contain sufficient scientific grounds that the Gupta programme is a legitimate treatment or cure for Fibromylagia. It should not be up to the patient to have to read and analyse scientific papers. Just because one study is published does not mean a method is scientifically backed – this is classic pseudoscience and overjustification. It is an attempt to give more medical and scientific authority to a still unproven and dubious method. It is highly likely that more people will be sucked in thinking that there is scientific justification where there isn’t.

The ASA were contacted regarding the publishing of this study as “proof” of treatment and they responded: “We’ve assessed the ad you highlighted and from the information we have, we think the ad is likely to have broken the Advertising Codes that we administer and therefore will be taking steps to address the issue. We will explain your concerns to the advertiser and provide guidance to them on the areas that require attention, together with advice on how to ensure that their advertising complies with the Codes.”

The current research in Fibromyalgia seems to be changing radically at the moment with it being recognised as an immune condition and not originating the brain. Like other conditions with ineffective treatment methods (Long Covid, ME/CFS, Lyme disease) there is a growing pressure from society and the medical community for them to be more thoroughly researched, more effective care given and for physical biomarkers and treatments to be found. We need to move away from giving psychological primary care and actually funding and researching these chronic conditions that create years of pain and suffering to mainly women who have been ignored. Let’s be on the right side of history and do everything we can to move away from the psychogenic paradigm and actual take these conditions seriously – this means not supporting and backing any form of primary psychological therapies including brain retraining in whatever form it takes.

Learn more

 * Vincent Racaniello virology blog