Gupta program

The Gupta Program or Gupta Programme or Amydala and Insula Retraining describes itself as "brain retraining" techniques designed "to alter amygdala and insula activity" in order to treat or cure chronic diseases including chronic fatigue syndrome and fibromyalgia. The Gupta program is based on the amygdala hypothesis of chronic fatigue syndrome, which is not peer reviewed, is unproven, and has not been a focus of research.

In 2018, the Gupta Program was found to be making unproven advertising claims including wrongly claiming that it can be used to treat fibromyalgia, electrical sensitivities as well as ME/CFS. The UK's ME Association charity refuses to accept adverts for the Gupta Program, and does not endorse it.

Alternative names
Other names used for the Gupta Program include: 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.
 * Amygdala Retraining Techniques (ART)
 * Amygdala Retraining Program (ARP)
 * Amygdala and Insula Retraining (AIR)
 * Gupta Amygdala Retraining
 * Gupta Programme

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 reviewed. The new hypothesis is described on the Gupta Program website but is not published or peer-reviewed research. 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.

This belief of "symptoms without disease" and the assumption that flawed illness beliefs exist that should be challenged are core parts of the cognitive behavioral model of ME/CFS and an hypothesis underlying the use of graded exercise therapy and the psychosomatic approach to medically unexplained symptoms, treatments associated with significant rates of harm. 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 World Health Organization's ICD-11 manual classes it as a neurological disease rather than a set of symptoms that may not indicate disease. 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".

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/ME, fibromyalgia and "electrical sensitivities" due to the lack of scientific evidence supporting this claim.

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. 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.

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.

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 reprogramming', cognitive behavior therapy, 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.

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-related illness and mast cell activation syndrome, and Ana Harris, who had mold-related illness.

Notable studies

 * 2020, Mindfulness-Based Program Plus Amygdala and Insula Retraining (MAIR) for the Treatment of Women with Fibro - (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.


 * 2012, A mind-body technique for symptoms related to fibromyalgia and chronic fatigue - (Full text)
 * The Advertising Standards Authority rejected this as evidence of effectiveness of the Gupta Program.
 * 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).

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 - (Full text)
 * The Advertising Standards Authority rejected this as evidence of effectiveness of the Gupta Program.
 * This was not published in an academic journal


 * 2002, Unconscious amygdalar fear conditioning in a subset of chronic fatigue syndrome patients - (Full text)
 * The Medical Hypotheses journal that published this is reported to be the world's most controversial journal, and describes itself as publishing hypothesis that are "radical, speculative and non-mainstream scientific ideas" and some "where experimental support is yet fragmentary". It is peer-reviewed.

Personal experiences

 * 2009, Amygdala Training part 1 Blog - Cort Johnson (archived)
 * 2012, A Psychotherapist Reviews Ashok Gupta’s Amygdala Retraining Program – Tamara Lewis
 * 2010, Just passed six months on the Gupta programme - Graham Stoney

Learn more

 * 2018, Advertising Standards Association complaint result
 * 2009, Q&A Session with Ashok Gupta developer of Amygdala Retraining Program for ME/CFS, FM - ProHealth (archived)