In clinical populations, CES has been used as an adjunctive treatment for several clinical disorders including insomnia, depression, post-traumatic stress disorder, and anxiety (Gunther and Phillips, 2010 Bracciano et al., 2012 Morriss and Price, 2020). This review describes past and present research and development efforts with this neuromodulatory technique, with emphasis on its potential for enhancing well-being in clinical contexts and optimizing or enhancing human performance in healthy, neurotypical populations. ![]() Establishing reliable empirical links between CES administration and human performance is critical for supporting its prospective use during occupational training, operations, or recovery, ensuring reliability and robustness of effects, characterizing if, when, and in whom such effects might arise, and ensuring that any benefits of CES outweigh the risks of adverse events.Ĭranial electrotherapy stimulation (CES) involves delivering low-intensity (50 μA to 4 mA) electrical current via a pair of electrodes attached to bilateral anatomical positions around the head (e.g., eyelids, earlobes, mastoids, temples), with the intent of acutely modulating central and/or peripheral nervous system activity. The lack of compelling evidence also motivates well-designed and relatively high-powered experiments to assess how CES might modulate the physiological, affective, and cognitive responses to stress. These limitations make it difficult to derive consistent or compelling insights from the extant literature, tempering enthusiasm for CES and its potential to alter nervous system activity or behavior in meaningful or reliable ways. In our critical review of studies using CES in clinical and non-clinical populations, we found severe methodological concerns, including potential conflicts of interest, risk of methodological and analytic biases, issues with sham credibility, lack of blinding, and a severe heterogeneity of CES parameters selected and employed across scientists, laboratories, institutions, and studies. There is no direct evidence supporting this theory, but one of its assumptions is that CES may induce its effects by stimulating afferent projections of the vagus nerve, which provides parasympathetic signals to the cardiorespiratory and digestive systems. One theory suggests that CES modulates brain stem (e.g., medulla), limbic (e.g., thalamus, amygdala), and cortical (e.g., prefrontal cortex) regions and increases relative parasympathetic to sympathetic drive in the autonomic nervous system. Computational modeling suggests that electrical current administered with CES at the earlobes can reach cortical and subcortical regions at very low intensities associated with subthreshold neuromodulatory effects, and studies using electroencephalography (EEG) and functional magnetic resonance imaging (fMRI) show some effects on alpha band EEG activity, and modulation of the default mode network during CES administration. The physiological, neurochemical, and metabolic mechanisms underlying CES effects are currently unknown. ![]() More recently, a limited number of studies have examined CES for altering affect, physiology, and behavior in healthy, non-clinical samples. Cranial electrotherapy stimulation (CES) is a neuromodulation tool used for treating several clinical disorders, including insomnia, anxiety, and depression.
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