Audio-Visual Entrainment: The Application of Audio-Visual Entrainment forthe Treatment of Seasonal Affective DisorderDavid Sieveri, Edmonton,Alberta, Canadahttp://mindalive.com/Abstract: Seasonal Affective Disorder (SAD) strikes all people from all nations, not just those near the poles of the earth as might be thought. The treatment of SAD has traditionally involved the use of antidepressants, and more recently, light bo! therapy.Audio"isual #ntrainment (A"#) has also been sho$n to be beneficial in the treatment of this genetically based affective disorder and its related an!ious%depressive%dietary conditions. ntroduction#ach year, &' of northern populations are affected $ith Seasonal Affective Disorder (SAD) and another ()' have a milder form of SAD, called the $inter blues. Surprisingly, SAD may occur at any time of year and in e*uatorial regions although theratio of northerners $ith SAD as compared to those living in the tropics is about (+(. ,eople in the southern -SA e!perience SAD in the summer from stayingindoors $here air conditioning allo$s them to escape the unbearable summer heat. ,eople have also e!perienced SAD moving into a basement suite or an office on the north side of a building or after painting the interior of their home a darker shade of color. ,eople have e!perienced SAD follo$ing the development of cataracts or after $earing sunglasses for an e!tended period of time and during overcast, rainy periods (.osenthal, (//0). The common symptoms are depression, an!iety, e!treme fatigue, hypersomnia, carbohydrate cravings, and $eight gain. 1omen bet$een the ages of 2+ to )+, their se!ually reproductive years, are most susceptible (.osenthal, (//0). The first controlled study using light therapy to treat SAD $as published in (/3). SAD $as officiallyaccepted as a clinical malady in (/34 by the American ,sychiatric Association and described in its then current diagnostic manual, the DS5666.. Since that time, a great number of studies on the topic have been completed.Animals are more sensitive to the seasons than humans, as they go through migration,mating, molting and hibernation. 7or instance, hamsters can sense the difference bet$een a (2hour day $hen their gonads don8t gro$ versus a (2hour and (9 minute day $hen their gonads begin gro$th. 6t is thought that humans aren8t as sensitive as animals because humans originated in and around Africa $here solar fluctuations are much more minimal than those near the #arth8s poles (1right, 2++2).Tic!-Toc! "oes the Cloc!6t must be understood that circadian timing has nothing to do $ith the sense of time lapsing bet$een events, nor the ability to notice differences in timing bet$een t$o events, such as t$o tonebursts or other sensory stimulation. Stimulation from events initiates an attentional cortical reset, $hich in turn synchroni:es brain activity. 5ore specifically, about 0++ milliseconds later, the brain generates an attentional spike kno$n as the ,0++ response. This spike starts a timing loop, initiated in the substantia nigra, a part of the basal ganglia, $hich in turn sends a burst of the neurotransmitter dopamine to another part of the brain called the striatum. The striatum contains ;spiny< cells, $hich oscillate at different fre*uencies. =ver time, the differences or ;beats< add up. 1hen attention is once again initiated, the count is recorded, providing a ;time stamp< for that interval, $hich higher levels of the brain then interpret into a sense of timing (1right, 2++2).The Captain and #inealAll species studied to date, from singlecelled organisms to humans, have been observed to have a biological clock. This clock is essential for survival, regulating various types and levels of arousal to provide cues for alertness, eating, sleep and the release of hormones. >ight $aves striking the retina activate electrical output that is sent do$n the optic nerve to the brain for visual processing. A secondary, smaller nerve tract from the retina, originating from speciali:ed cells that utili:e a light detecting pigment called melanopsin, also carries signals to the suprachiasmic nucleus(S?@) of the hypothalamus. The S?@, in turn, sends nervous outputs to various parts of the brain including the pineal gland. 7our genes that govern circadian cycles in flies,mice and humans have been discovered that not only reside $ithin the S?@, but in all cells of the body. 1hen cultured in a petri dish under constant lighting, these cells continue $ith gene activity, hormone secretion and energy production in a 2)hour cycle that varies less than (' (1right, 2++2).6n the mid 4+s, Dr. Alfred >e$y of the @ational 6nstitute of 5ental Aealth (@65A) discovered the neurotransmitter melatonin. The $ake%sleep cycle in animals and humans is controlled by melatonin, $hich is produced by the pineal gland, a structure the si:e of a pea and located in the midbrain. #very night, the pineal gland e!cretes melatonin into the bloodstream and continues to do so until da$n. Ao$ever, under normal e!posure to sunlight, secretions of melatonin follo$ the earth8s light%dark time frame and therefore more melatonin is typically released during the long dark hours ofthe $inter months. Aenceforth, the pineal gland is in charge or ;captains< our $ake%sleep arousal states.$no%in& if 'e (ave SADAlthough most an!iety and depression inventories could be used to detect SAD, one popular SAD test is the Seasonal ,attern Assessment Buestionnaireor S,AB, developedby .osenthal and his colleagues at the @65A. The S,AB is a selfassessment *uestionnaire that evaluates one8s level of SAD from four basic categoriesC(),attern of seasonality2)Degree of seasonality0)The degree that seasonal changes are a problem for you))#valuating other related informationSAD and )rain *unction7e$ ,#T or S,#?T studies of brain metabolism in SAD persons have emerged and theyare inconsistent in results. Doth ?ohen, et al8s, ((//2) positron emission tomography (,#T) study and a single photon emission computeri:ed tomography (S,#?T) study by 5urphy, et al. ((//0) $ere inconsistent in results. The results of electroencephalographic (##E) studies are also inconsistent and involve fe$ electrode sites ("olf F ,assynkova, 2++2). =ne such study suggests increased left frontal alpha activity as compared to the right (Allen, et al., (//0), $hich is consistent $ith commonunderstandings of depression. Another found all activity e!cept alpha $as higher in the left posterior region (Teicher, et al., (//&) $hile another study sho$ed increased thetaalpha at ?0 (?ajochen et al., (//&). "olf sought to finally put the debate to rest by comparing (& site B##Es of 0( depressed SAD patients against those of controls. Darring technical issues (a digital filtering concern of aliasing error, possibly invalidating all data, arises $ithin the study), he found asymmetries of delta, theta and alpha involving heightened ##E activity in the right parietal and temporal regions.An asymmetry of heightened beta ##E occurred in lateral frontal regions (74 F 73).TreatmentA number of coping techni*ues are used to reduce the symptoms of SAD. These include long $alks outside, aerobic e!ercise, a diet rich in comple! carbohydrates and protein, relocating to sunnier locations, $inter vacations to tropical areas, and fre*uenting suntanning centres. >ightbased clinical interventions include light bo! therapy and audiovisual entrainment.;>ight bo!< therapy has been used to reduce the symptoms of SAD in &+' to 3+' of SAD patients (>am, (///). 1hite light therapy, using intensities of 2,9++ lu!, re*uires e!posure times from 2 to & hours, a considerable behavioral investment for the user (Terman, et. al., (/3/). >ight e!posures in the intensity of (+,+++lu! for 0+minute e!posures havebeen found to be more effective than 2,9++ lu! intensity $ith e!posuretimes of several hours (Terman, et.al., (//+). Some people have reported that overuse of light therapy can leave them feeling ;$ired< and restless (.osenthal, (//0).Audio"isual #ntrainment (A"#) using flashing lights and pulsing tones has been sho$nto enhance ##E activity at the stimulation fre*uency. Ao$ever, a lesser kno$n attribute of A"# lies in its inhibition effect at roughly the halffre*uency of stimulation (Siever, 2++0). 6n B##Es (brain maps) collected at our office of those $ith SAD, $e have observed long spindles of (+ A: alpha brain$ave activity, globally, $ith particularly increased activity in the left frontal regions, consistent $ith Allen8s findings. 6n light of these findings, $e had chosen to utili:e 2+ A: A"# as a treatment modality for SAD.SAD Stud+ ,sin& Audio-Visual Entrainment-ethodThe Digital Audio"isual 6ntegration Device (DA"6D) ,aradise by ?omptronic Devices >imited (no$ 5ind Alive 6nc.) $as used in a )$eek randomi:ed study of 4) SAD sufferers (92 females and 22 males, avg. age G 03.9 years) to reduce the symptoms ofSAD through the application of A"#. The participants $ere screened according to the DS56", SAD re*uirements. The study accepted participants from @ovember (//3 to 5arch (///from #dmonton, Alberta ($hich is located appro!imately90.9 northern latitude).#rocedureThe Deck Depression 6nventory (DD6) and the An!iety Sensitivity 6nde! (AS6) $ere usedfor the pretest, posttest (placebo), and the postposttest (treatment) results. A daily diary $as maintained to record total sleep time, sociability at $ork and $ith the family, eating, appetite and carbohydrate intake, cravings, energy and body $eight. The participants $ere divided into t$o groupsC a ?ontrol Eroup (?E) that did not receive the DA"6D A"# unit and the Treatment Eroup (TE) that received ;placebo< and treatment sessions. The Treatment Eroup received subdelta (placebo) fre*uencies of ( A: for t$o$eeks follo$ed by beta fre*uencies (treatment sessions) of 2+ A: for t$o$eeks. 7iftyeight treatment participants and (& control participants finished the study. ,aired ttests $ere used in the $ithin group measurements, and the analysis of variance (A@="A) $as used in the bet$een group measurements..esultsThe pretest DD6 score for both groups $as 2+.(. A score above nine indicates at least mild depression. Depression $ithin the ?E increased by 23' to a score of 2&.(. A reduction in depression for 0&' of the participants $as observed in the TE during the placebo condition and during actual treatment (the beta A"# group) (++' of the participants had reduced depression (DD6 G 4.0, pH+.++(), as sho$n in 7igure (. *i&ure / Comparison of )D scores bet%een controls, placebo 0 treatment &roups =f these, 3)' became clinically nondepressed. The A"# male population an!iety sensitivity (AS) decreased significantlyfrom 2(' to &+' (pH+.++() from post to postpost, respectively $hile the control male population had a 4' increase in AS. The A"# female population sho$ed decreased AS, from (9' to 0)' (pH+.++() from post to postpost respectively, $hile the control groupsho$ed a mild reduction of &'.*i&ure 1 Comparison of AS scores bet%een pre, post and post-post results.Daily diary results (7igure 0) indicated marked improvements.,ositive moods improvedby 2+'.Sociability at home $ith the familyand at $ork improved by 22' and )+' respectively.*i&ure 2 Comparison of measures from pre to post-post conditions.As sho$n in 7igure ), A"# participants8 food intake changedI over eating decreased by (3', appetite decreased by (2', and carbohydrate intake decreased by (9'. The participants also reported happiness $ith their increased energy (average increase of (3').*i&ure 3 Comparison of pre and post-post measures.The daily diary results also sho$ed that by using A"#, some participants lost considerable $eight.A group of (2 participants (3 females and ) males) reported that their average $eight gain during the $inter months $as (9 pounds. During the placebo condition, they had an average $eight loss of 0 pounds ((.0& Jg) plus an additional average $eight loss of &.9 pounds ().0 Jg) during the t$o$eek treatment condition. Conclusion1hite light A"# at 2+ A: produced significant results. Although subdelta fre*uencies are noneffective at generating entrainment, subdelta fre*uencies can affect both dissociative mind states and cerebral blood flo$ (7o! F .aichle, (/39). 6n addition, the ;placebo effect< could also e!plain the subdelta significance. The ;placebo effect< hasbeen sho$n to reduce an!iety, increase endorphin production, conditioning, and e!pectancy (Eodfroid, (//3). Deing that inade*uate light elicits depression in SAD sufferers, the ;placebo effect< via photic stimulation is possible.The A"# Eroup8s depression decreased $hile the ?ontrol Eroup8s depression increased. Sensitivity to an!iety decreased in both male and female A"# groups. Although the female control participants had decreased sensitivity to an!iety, the female A"# population sho$ed significance bet$een the ( A: and 2+ A: stimulation. 5ost control group participants claimed that they gained $eight $hereas an additionalbenefit of A"# is $eight loss. =ne participant claimed that, ;after using the 2+ A: session for 2 $eeks, the taste of s$eets in my mouth $as repulsive.< 7ollo$up reportsindicate participants8 SAD symptoms returned $ithin an average of 2 $eeks after discontinuing use of the DA"6D A"# device. .eferencesAllen, K., >ocono, 1., Depue, .., F Arbisi, ,. ((//0). .egional encephalographic asymmetries in bipolar seasonal affective disorder before and after e!posure to bright light. Diological ,sychiatry, 00, &)2&)&.?ajochen, ?., Drunner, D., Jrauchi, J., Era$, ,., F 1ir:Kustice, A. (2+++). ##E and subjective sleepiness during e!tended $akefulness in seasonal affective disorderC circadian and homeostatic influences. 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