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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" /> 
The '''Gupta programme''' or '''Gupta Amydala Retraining''' describes itself as a "[[brain training]]" or "brain re-wiring" technique designed to alter [[amygdala]] and [[insular]] activity in order to treat or cure chronic diseases including [[chronic fatigue syndrome]].<ref name="Gupta2002">{{Cite journal|last=Gupta|first=Ashok|author-link=Ashok Gupta|date=2002|title=Unconscious amygdalar fear conditioning in a subset ofchronic 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><ref name=":0">{{Cite web|url=https://www.asa.org.uk/rulings/harley-street-solutions-ltd-a17-400324.html|title=Harley Street Solutions Ltd|last=Practice|first=Advertising Standards Authority {{!}} Committee of Advertising|website=www.asa.org.uk|access-date=2020-08-29}}</ref> The Gupta programme is based on the [[amygdala hypothesis]] of [[chronic fatigue syndrome]], which is unproven and has not been a significant focus of research.<ref name="Gupta2002" /> The Gupta Programme has previously claimed to treat [[fibromyalgia]] and [[Electrical hypersensitivity|electrical sensitivities]] as well as ME/CFS.
 
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 ==
Evidence is largely limited to patient self-reports. The British Advertising Standards Authority has upheld complaints about the Gupta Programme 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.<ref name=":0" />
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>


==Reported harms ==
===Amygdala and insula activity changes ===
Some people have reported being harmed by brain training programmes, including [[Jen Brea]], who has ME/CFS, 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|url=https://twitter.com/jenbrea/status/961677015286874112?lang=en}}</ref><ref name=":1">{{Cite web|url=http://anaharriswrites.com/my-brain-retraining-story/|title=My Brain Retraining Story – Ana Harris Writes|last=Harris|first=Ana|language=en-US|access-date=2020-09-25}}</ref>
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.


== Theory ==
===Evidence from coaches ===
Both Brea and Harris criticized the 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 Programme.<ref name="JenTweets" /><ref name=":1" />
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.


This belief of "symptoms without disease" is also core part 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=|first=|date=May 2015|website=meassociation.org|publisher=ME Association|archive-url=|archive-date=|dead-url=|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>{{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|author-link =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=www.investinme.org|archive-url=|archive-date=|dead-url=|access-date=2019-07-02}}</ref> This "not a disease" theory provides justification for the Gupta Programme 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]] 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|last2=|first2=|authorlink2=|date=|website=icd.who.int|archive-url=|archive-date=|dead-url=|access-date=2020-09-25}}</ref>
==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 ==
==See also ==
*[[Brain training]]
*[[Criticisms of The Gupta Program]]
*[[Ashok Gupta]]
*[[Brain retraining]]
*[[Pseudoscience]]
*[[Mindfulness]]


==Learn more ==
==Learn more ==
* [https://www.asa.org.uk/rulings/harley-street-solutions-ltd-a17-400324.html Advertising Standards Association complaint result] (2018)
* 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 ==
==References ==
{{Reflist}}
[[Category:Psychological paradigm]]
[[Category:Psychological paradigm]]
[[Category:Psychological and behavioral therapies]]
[[Category:Psychological and behavioral therapies]]
[[Category:Potential treatments]]
[[Category:Potential treatments]]
[[Category:Brain training]]
[[Category:Brain training]]
<references />

Latest revision as of 10:31, April 2, 2023

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.[1][2][3] 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.[1][2]

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.[3] The UK's ME Association charity refuses to accept adverts for the Gupta Program, and does not endorse it.[4][5]

Alternative names[edit | edit source]

Other names used for the Gupta Program include:

  • Amygdala Retraining Techniques (ART)
  • Amygdala Retraining Program (ARP)[6]
  • Amygdala and Insula Retraining (AIR)
  • Gupta Amygdala Retraining[3]
  • Gupta Programme[3]

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.[2]

Theory[edit | edit source]

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.[2] The new hypothesis is described on the Gupta Program website but is not published or peer-reviewed research.[7][8] 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.[9][10]

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.[11][12][13][14] 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.[15] 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".[16]

Evidence[edit | edit source]

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.[3]

Amygdala and insula activity hypothesis[edit | edit source]

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.[17] 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.[18]

Amygdala and insula activity changes[edit | edit source]

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[edit | edit source]

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]

Safety concerns raised by clinicians[edit | edit source]

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.[5]

Reported harms from patients[edit | edit source]

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.[9][10]

Notable studies[edit | edit source]

  • 2020, Mindfulness-Based Program Plus Amygdala and Insula Retraining (MAIR) for the Treatment of Women with Fibro[2] - (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.[19]
  • 2012, A mind-body technique for symptoms related to fibromyalgia and chronic fatigue[20] - (Full text)
The Advertising Standards Authority rejected this as evidence of effectiveness of the Gupta Program.[3]
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).[20]

Articles not peer reviewed or from non-academic journals[edit | edit source]

  • 2010, Can amygdala retraining techniques improve the wellbeing of patients with chronic fatigue syndrome? A clinical audit of subjective outcomes in a small sample[21] - (Full text)
The Advertising Standards Authority rejected this as evidence of effectiveness of the Gupta Program.[3]
This was not published in an academic journal[22]
  • 2002, Unconscious amygdalar fear conditioning in a subset of chronic fatigue syndrome patients[1] - (Full text)
The Medical Hypotheses journal that published this is reported to be the world's most controversial journal,[23] and describes itself as publishing hypothesis that are "radical, speculative and non-mainstream scientific ideas" and some "where experimental support is yet fragmentary".[24][25] It is peer-reviewed.

Personal experiences[edit | edit source]

See also[edit | edit source]

Learn more[edit | edit source]

References[edit | edit source]

  1. ↑ 1.0 1.1 1.2 Gupta, Ashok (2002). "Unconscious amygdalar fear conditioning in a subset of chronic fatigue syndrome patients" (PDF). Medical Hypotheses. 59 (6): 727–735.
  2. ↑ 2.0 2.1 2.2 2.3 2.4 Sanabria-Mazo, Juan P.; Montero-Marin, Jesus; Feliu-Soler, Albert; Gasión, Virginia; Navarro-Gil, Mayte; Morillo-Sarto, Héctor; Colomer-Carbonell, Ariadna; Borràs, Xavier; Tops, Mattie; Luciano, Juan V.; García-Campayo, Javier (October 2020). "Mindfulness-Based Program Plus Amygdala and Insula Retraining (MAIR) for the Treatment of Women with Fibromyalgia: A Pilot Randomized Controlled Trial". Journal of Clinical Medicine. 9 (10): 3246. doi:10.3390/jcm9103246. ISSN 2077-0383. PMC 7599726. PMID 33050630.
  3. ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 Advertising Standards Authority | Committee of Advertising Practice (April 11, 2018). "Harley Street Solutions Ltd". Advertising Standards Authority. Retrieved August 29, 2020.
  4. ↑ ME Association (September 19, 2012). "New advertising feature started on MEA website | 19 September 2012". ME Association. Retrieved June 3, 2022. We respectfully decline any contact from practitioners offering the Lightning Process, Gupta Programme, Mickel Therapy, or any similar training courses.
  5. ↑ 5.0 5.1 Shepherd, Charles (May 30, 2015). "Alternative and complementary approaches to management" (PDF). ME Association. Retrieved June 3, 2022. 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.
  6. ↑ "12th Biennial Conference Syllabus" (PDF). IACFS/ME. October 2016.
  7. ↑ Gupta, Ashok. "Gupta Program | The Secret of Amygdala Retraining". The Gupta Program. Retrieved June 4, 2022.
  8. ↑ Gupta, Ashok (February 2021). "Medical Pager Final Version" (PDF). The Gupta Program. Retrieved June 4, 2022.
  9. ↑ 9.0 9.1 @jenbrea (February 8, 2018). "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" (Tweet) – via Twitter.
  10. ↑ 10.0 10.1 Harris, Ana (September 11, 2018). "My Brain Retraining Story". Ana Harris Writes. Retrieved September 25, 2020.
  11. ↑ ME Association (May 30, 2015). "ME/CFS Illness Management Survey Results - "No decisions about me without me" Part 1" (PDF). ME Association.
  12. ↑ Oxford Clinical Allied Technology and Trials Services Unit (OxCATTS) (February 27, 2019). "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" (PDF). Oxford Brookes University.
  13. ↑ Action for ME (2014). "Time to deliver: initial findings of Action for ME's 2014 survey" (PDF). Retrieved July 1, 2016.
  14. ↑ Invest in ME Research (July 2, 2017). "Response to NICE 10 year surveillance (2017) – Chronic fatigue syndrome/myalgic encephalomyelitis". Invest in ME Research. Retrieved July 2, 2019. CBT/GET have been proven to be based on non-science for ME and should be removed from any recommendations in the guideline.
  15. ↑ World Health Organization. "ICD-10 Version:2016". World Health Organization. Retrieved September 25, 2020.
  16. ↑ Goudsmit, EM; Howes, S (2008). "Pacing: a strategy to improve energy management in chronic fatigue syndrome". Health Psychol Update. 17: 46–52. 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.
  17. ↑ Centers for Disease Control and Prevention (2018). "Possible Causes | Information for Healthcare Providers | Myalgic Encephalomyelitis/Chronic Fatigue Syndrome ME/CFS". CDC. Retrieved June 1, 2022.
  18. ↑ "The Top 10+ ME/CFS research priorities are here!". Priority Setting Partnership. 2022. Retrieved June 1, 2022.
  19. ↑ "Our Professional Team of Coaches". Gupta Program. Retrieved June 3, 2022.
  20. ↑ 20.0 20.1 Toussaint, Loren L.; Whipple, Mary O.; Abboud, Lana L.; Vincent, Ann; Wahner-Roedler, Dietlind L. (March 2012). "A mind-body technique for symptoms related to fibromyalgia and chronic fatigue". Explore (New York, N.Y.). 8 (2): 92–98. doi:10.1016/j.explore.2011.12.003. ISSN 1878-7541. PMID 22385563.
  21. ↑ Gupta, A (September 2010). "Can amygdala retraining techniques improve the wellbeing of patients with chronic fatigue syndrome? A clinical audit of subjective outcomes in a small sample" (PDF). Journal of Holistic Healthcare. 7 (2): 12–15. Archived from the original (PDF) on November 11, 2011. Retrieved June 2, 2022.
  22. ↑ "Journal - information for contributors". British Holistic Medical Association. Retrieved June 3, 2022.
  23. ↑ Cressey, Daniel (March 18, 2010). "Editor says no to peer review for controversial journal". Nature. doi:10.1038/news.2010.132. ISSN 1476-4687.
  24. ↑ "Guide for authors - Medical Hypotheses - ISSN 0306-9877". Elsevier. Retrieved June 3, 2022.
  25. ↑ "Medical Hypotheses | Journal". ScienceDirect.com by Elsevier. Retrieved June 3, 2022.

amygdala Part of the brain, within the temporal lobe. Related to memory and emotional behavior.

amygdala Part of the brain, within the temporal lobe. Related to memory and emotional behavior.

somatic symptom disorder A psychiatric term to describe an alleged condition whereby a person's thoughts somehow cause physical symptoms. The actual existence of such a condition is highly controversial, due to a lack of scientific evidence. It is related to other psychiatric terms, such as "psychosomatic", "neurasthenia", and "hysteria". Older terms include "somatization", "somatoform disorder", and "conversion disorder". Such terms refer to a scientifically-unsupported theory that claims that a wide range of physical symptoms can be created by the human mind, a theory which has been criticized as "mind over matter" parapsychology, a pseudoscience.

flare-up A symptoms flare in ME/CFS is a temporary increase in symptoms, alternatively known as experiencing post-exertional malaise. May be referred to as a "crash" or "collapse".

chronic disease a disease or condition that usually lasts for 3 months or longer and may get worse over time. Chronic diseases are long-term (typically incurable and requiring long-term management) but are not necessarily severe.

subjective outcome An outcome of a clinical trial that depends on the judgement or opinion of the assessor or patient, e.g. asking if fatigue has increased or decreased "a little" or "a lot", patient questionnaires like the Chalder Fatigue Scale, and other patient-reported outcome measures (PROMs).

cognitive behavioral therapy (CBT) - A type of psychotherapy geared toward modifying alleged unhealthy thinking, behaviors or illness beliefs. One of the treatment arms used in the controversial PACE trial.

graded exercise therapy (GET) - A gradual increase in exercise or activity, according to a pre-defined plan. Focuses on overcoming the patient's alleged unhelpful illness beliefs that exertion can exacerbate symptoms, rather than on reversing physical deconditioning. Considered controversial, and possibly harmful, in the treatment or management of ME. One of the treatment arms of the controversial PACE trial.

Centers for Disease Control and Prevention (CDC) - The Centers for Disease Control and Prevention is a U.S. government agency dedicated to epidemiology and public health. It operates under the auspices of the Department of Health and Human Services.

holistic Treating mind, body and spirit together, with the aim of achieving wellness and good health. May be within modern medicine or alternative / traditional medicine.

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