Effectiveness of Alpha-Stim Technology:
2011 Military Service Member and Veteran Survey
With A Comparison to Drug Surveys
Larry R. Price, PhD, Associate Dean of Research and Professor of Psychometrics and
Statistics, Texas State University.
Francine Nichols, RN, PhD, Professor Emeritus, Georgetown University
Jeff Marksberry, MD, FAIS, Science and Education Director, Electromedical Products
International, Inc.
Service Members and Veterans are considered more difficult to treat as a group than a civilian population because of their experiences in combat. For example, the most common major injuries suffered by those active duty Service Members who served in the Iraqi and Afghanistan theaters of operations are amputations, traumatic brain injury, post-traumatic stress disorder (PTSD) and other mental health disorders. Since 2002, approximately one-third of Veterans from these conflicts have sought mental health care from a VA Medical Center (Goldberg, M.S. congressional Budget Office Testimony, December 17, 2007). In comparison, in a 2008-2009 survey of civilians, 3.2% of participants reported having serious psychological distress in the past 30 days (National Center for Health Statistics, 2011). The incidence of PTSD is estimated to be 11-20% of Veterans of the Iraq and Afghanistan wars – Operations Iraqi and Enduring Freedom. In contrast, about 7-8% of the adult civilian Americans will have PTSD at some point in their lives (US Department of Veterans Affairs, 2011).
Sleep problems are also a major issue for Service Members returning from a deployment, especially if they were in a combat area (Luxton, D.D., Greenburg, D., Ryan, J., Niven, A., Wheeler, G. & Mysliwiec, V., 2011). In a cross-sectional study of a brigade combat team that included 2,738 subjects between 90 and 180 days after return to their United States base, 1,959 (72 %) reported they slept ≤ than 6 hours which is defined as short sleep duration (SSD). This short sleep duration was associated with symptoms of depression, PTSD, panic syndrome and high risk behaviors such as abuse of tobacco and alcohol products, and suicide attempts. In a survey of the prevalence of insomnia in a general United State sample of 6,139 individuals over the age of 16, 1.2 % of individuals reported they had insomnia (Ram S, Seirawan H, Kumar S.K. & Clark, G.T., 2010).
Department of Defense (DOD) and Veterans Administration (VA) practitioners prescribe Alpha-Stim for the treatment of anxiety, PTSD, insomnia, depression, pain, headaches and substance abuse. Alpha-Stim units are manufactured by Electromedical Products International, Inc., (www.alpha-stim.com) a 30 year old medical device company located in Mineral wells, Texas. Alpha-Stim is a FDA cleared prescriptive electromedical device about the size of a smart phone. It uses two electrodes that clip onto the ear lobes sending a mild electrical current through the brain to induce a calm, relaxed, yet alert state of mind in a 20 – 60 minute treatment (cranial electrotherapy stimulation). For the treatment of pain, service members can also use adhesive pad or probe electrodes for localized pain (microcurrent electrical therapy). During the past decade, Alpha-Stim devices have been ordered by over 70 VA medical centers and 15 military medical facilities. The Army and the National
Institutes of Health have funded major research studies that are currently investigating the effectiveness of Alpha-Stim technology.
The Survey
The purpose of this survey was to examine Service Members and Veterans’ perceptions of the effectiveness of Alpha-Stim technology. It was conducted as part of the requested post marketing surveillance for the U.S. Food and Drug Administration (FDA). One-thousand five hundred fourteen (N=1,514) active duty Service Members and Veterans who had obtained an Alpha-Stim through the Department of Defense (DOD) or Veterans Affairs Medical Centers (VAMC) were invited to participate in the web-based survey via email. Email addresses were obtained from prescription information for Alpha-Stim devices that was on file at Electromedical Products International, Inc. The complete survey is shown in Appendix A.
The questionnaire contained 27 questions that covered the following areas: demographic information, prescription medication use, current exercise activity, and questions asking respondents to rate the effectiveness of Alpha-Stim technology for treating anxiety, PTSD, insomnia, depression, pain and headaches.
The method of survey delivery was web-based and was conducted through Survey Monkey, www.surveymonkey.com, a professional on-line survey website for market and product research. Respondents completed the questionnaire on-line from September 1, 2011 to October 1, 2011. Due to the goal of this research, the sampling strategy used in this study was purposive. Of the 1,514 persons who were invited to participate in the survey, one hundred fifty two (N=152) responses to the questionnaire were received yielding a response rate of 10%. Although response rates vary by the population sampled, a response rate somewhere between 15% and 40% is common for web based surveys (Czaja, R. & Blair, J., 2005, pps. 40-43; Dillman, D., 2007). See Table 1 for the characteristics of respondents.
Table 1. Respondent Characteristics
| Characteristics | Mean, SD, Percent |
| Age | |
| Range, 19 and 67 years | M=38, SD=10 |
| Active Duty Service Members | 72 % |
| Veterans | 28 % |
| Gender | |
| Male | 75% |
| Female | 22 % |
| No Response | 3 % |
| Currently Using Alpha-Stim? | |
| Yes | 82 % |
| No | 15 % |
| No Response | 3 % |
| Currently taking at least one prescription drug? | |
| Yes | 73 % |
| No | 27 % |
| Currently Exercise Regularly? | |
| Yes | 76 % |
| No | 24 % |
Table
2 shows respondents use of Alpha-Stim technology: conditions for which they used Alpha-Stim, how often they used Alpha-Stim and the length of time they had used Alpha-Stim.
| Conditions for which Respondents used Alpha-Stim technology* | |
| Anxiety (N=114) | 75 % |
| Depression (N=101) | 66 % |
| Insomnia (N=92) | 60 % |
| PTSD (N=82) | 53 % |
| Pain (N=73) | 48 % |
| Headaches (N=73) | 48 % |
* Respondents marked all conditions for which they used Alpha-Stim.
Table 2. Respondents Use of Alpha-Stim technology
| How often Respondents used Alpha-Stim | |
| Once a day | 55 % |
| Twice a day | 16 % |
| Two to three times a day | 6 % |
| Three or more times a day | 3 % |
| No Response | 23 % |
| Length of Time Using Alpha-Stim | |
| 90 Days | 4.6 % |
| 4 Months | 4.0 % |
| 5 Months | 2.6 % |
| 6 Months | 4.6 % |
| 9 Months | 2.6 % |
| 1 Year | 6.6 % |
| 2 Years | 7.2 % |
| 3 Years | 2.0 % |
Impact of Medication Use
It is important to consider the impact of taking regular medication as a confounding factor in relation to the reported effect of Alpha-Stim for the treatment of one or more of the following: anxiety, PTDS, insomnia, depression, pain and headaches. The respondents reported using medication for the following conditions: 40% for some level of depression, 25% for pain and depression, 13% for pain only, 10% reported using medication for insomnia, and 2% for insomnia and depression. In addition to analysis for the total valid N, analysis of the improvement-related survey questions were also interpreted in light of subjects taking or not taking prescription medication while using Alpha-Stim.
Effectiveness of Alpha-Stim by Condition
Respondents were asked to rate improvement in their condition (anxiety, PTSD, insomnia, depression, pain, and headache) based on using Alpha-Stim. For the treatment of anxiety, PTSD, insomnia, depression and headaches subjects used Alpha-Stim cranial electrotherapy stimulation (CES) using ear clip electrodes. For treatment of pain, subjects used Alpha-Stim probes or self-adhesive electrodes (Alpha-Stim microcurrent electrical therapy – MET) and CES ear clip electrodes. There were 152 responses on this variable. Seven (7) non-responses were observed yielding a valid sample size of N=145 for this analysis.
Anxiety
Thirty-one (31) subjects (21.3%) reported that they were not currently using Alpha-Stim for anxiety. One hundred fourteen (114) subjects (combined sample taking and not taking prescription medications regularly) using Alpha-Stim for anxiety responded to, “If you are using Alpha-Stim for anxiety, since starting Alpha-Stim, rate your improvement as …?” Figure 1 shows the results for the total group (N=114), the Alpha-Stim only no medication group (N=26), and the Alpha-Stim medication group (N=88).
Figure 1. Service Members changes in anxiety from using Alpha-Stim: With and without medication.
Post Traumatic Stress Disorder (PTSD)
Fifty-six (56) of the subjects (38.6%) reported not using Alpha-Stim for PTSD. PTSD is an anxiety disorder. It was included as a separate variable because of its importance in the treatment of Service Members and Veterans. Eighty-eight (88) subjects (combined sample taking and not taking prescription medication regularly) using Alpha-Stim for PTSD responded to “If you are using Alpha-Stim for PTSD, since starting Alpha-Stim, rate your improvement as…?” The findings of the total group (N=88), Alpha-Stim only no medication group (n=18), and Alpha-Stim and medication group (n=70) are shown in Figure 2.
Figure 2. Service Members changes in PTSD from using Alpha-Stim: With and without medication.
Insomnia
Forty-six (46) subjects (31.7%) reported that they did not use Alpha-Stim for insomnia. Ninety-eight (98) subjects (combined sample taking and not taking prescription medication regularly) who used Alpha-Stim for insomnia responded to, “If you are using Alpha-Stim for insomnia, since starting Alpha-Stim, rate your improvement as…?” The findings of the total group (N=98), Alpha-Stim only no medication group (N=21), and Alpha-Stim medication group (N=77) are shown in Figure 3.
Figure 3. Services Members Changes in Insomnia from using Alpha-Stim: With and without medication.
Depression
Fifty-six (56) subjects (38.6%) reported that they were not using the Alpha-Stim for depression. Eighty-nine (89) subjects (subjects combined sample taking and not taking prescription medication regularly) using Alpha-Stim for depression responded to “If you are using Alpha-Stim for depression, since starting Alpha-Stim, rate your improvement as…?”. The findings of the total group (N=89), Alpha-Stim only no medication group (N=13), and Alpha-Stim medication group (N=76) are shown in Figure 4.
Figure 4. Service Members changes in depression from using Alpha-Stim: With and without medication.
Pain
Seventy-two (72) subjects (49.6%) reported not using the Alpha-Stim for pain. Seventy-three (73) subjects (combined not taking and taking medication) using Alpha-Stim for pain responded to “If you are using Alpha-Stim for pain, since starting Alpha-Stim, rate your improvement as…?” The findings of the total group (N=73), Alpha-Stim only no medication group (N=13), and Alpha-Stim medication group (N=60) are shown in Figure 5.
Figure 5. Service Members changes in pain from using Alpha-Stim: With and without medication.
Headaches
Seventy-five (75) subjects (51.7%) reported not using Alpha-Stim for headaches. Seventy (70) subjects (combined not taking and taking medication group) using Alpha-Stim for headaches responded to “If you are using Alpha-Stim for headaches, since starting Alpha-Stim, rate your improvement as…?” The findings from the total group (N=70), Alpha-Stim only no medication group (N=17), and Alpha-Stim medication group
(N=53) are shown in Figure 6.
Figure 6. Service Members Changes in Headaches from Using Alpha-Stim: With and without medication.
Respondents Perceptions of the Safety and Effectiveness of Alpha-Stim
Of the 145 persons responding to “Do you consider Alpha-Stim safe and effective?” 99 percent (99%) reported that they view Alpha-Stim as being safe and effective. Of the 1% of respondents (N=2) reporting Alpha-Stim as unsafe or ineffective, the reasons given were (1) that they were never shown how to use Alpha-Stim properly, and (2) Alpha-Stim was simply ineffective for their medical condition in their experience. Respondents’ perceived improvement from using Alpha-Stim for each variable is shown in Figure 7. The findings of this survey show that subjects ratings of improvement from using Alpha-Stim ranged from 65.6% for pain to 90.3% for anxiety. A comparison of the Alpha-Stim medication and the Alpha-Stim only no medication groups revealed that the Alpha-Stim only no medication group rated the effectiveness of Alpha-Stim better for anxiety, PTSD, insomnia, pain and headaches than the Alpha-Stim medication and the total combined groups. The Alpha-Stim only no medication group’s reported effectiveness on depression from using Alpha-Stim was 76.9% while the Alpha-Stim medication and total combined groups scores were 78.9% and 78.6% respectively.
Figure 7. Service Members Reported Improvement from Using Alpha-Stim
Comparison of the Effectiveness of Alpha-Stim with Drug Therapy
Several of the most common drugs used to treat anxiety, PTSD, insomnia, depression, pain and headaches were compared to the findings of the Alpha-Stim Service Members and civilian surveys (See Figure 8).
Figure 8. Alpha-Stim Military and Civilian Surveys Compared to WebMD Drug Surveys.
The Alpha-Stim civilian survey was conducted in August 2011 from data collected between July 2006 and July 2011. The final sample size from the civilian survey was 1,745 responders from a mail survey of 4,590 (38% useable responses). Details of this survey can be found at www.Alpha-Stim.com. The data used for each drug were collected from on-line WebMD user surveys. The WebMD drug survey asked civilians the question: “This medication has worked for me?” Respondents could choose to answer in one of five categories, with “1” being the lowest to “5” being the most effective. The sample size for the drugs selected ranged from N=62 to N=2,238. The Alpha-Stim survey questionnaires asked respondents to rate their improvement for a specific condition based on using Alpha-Stim. Subjects could choose one of seven categories: Worse (negative change,), No Improvement (0%), Slight Improvement (1 – 24%), Fair Improvement (25 – 49%), Moderate Improvement (50 – 74%), Marked Improvement (75 – 99%), and Complete Recovery (100%).” While the questions in the WebMD and Alpha-Stim surveys were slightly different, all surveys asked questions about effectiveness. The WebMD data were changed to percent and ranged from 1 – 100%. Two categories were excluded from the Alpha-Stim survey as they were not included in the WebMD survey, Worse (negative change) and No Change (0%). The categories of “worse (negative change)” or “no change” reflected < 1 % of the responses in all instances (i.e. on all questions). The upper five categories which ranged from 1 – 100% were used for comparison. The scale was the same, 1 – 100% for the data from all surveys. The comparison of the data from the two surveys is both appropriate and justifiable based on the item content (i.e. content/construct validity) and the format of item response (American Educational Research Association, American Psychological Association, National Council on Measurement in Education, 1999; Czaja, R. & Blair, J., 2005).
Determining Important Clinical Improvement
Dworkin and colleagues (2008) defined the criteria for important clinical improvement: moderate clinical importance is ≥30 percent mprovement and substantial clinical importance, the highest category, is ≥ 50 percent improvement. Using a conservative approach, the “Slight Improvement” category on the 2011 Alpha-Stim Service Members and Veterans survey was excluded and the top three categories, “Fair improvement”, “Moderate improvement” and “Marked improvement” were collapsed into one category, which included responses that ranged from 25% – 100% improvement. Figure 9 shows subjects perceptions of clinical improvement from using Alpha-Stim on the variables of anxiety, PTSD, insomnia, depression, pain and headaches. Respondents reported improvement in the highest category, “substantial clinical importance,” (≥ 50% improvement) on the variables: anxiety, PTSD, insomnia, depression, and headaches. For pain, 45.2% of the respondents reported information that is categorized as being of moderate clinical importance.
Figure 9. Service members who had improvement of important clinical importance as defined by Dworkin and colleagues (2008). Those variables at or above the red line, ≥ 50% are in the category substantial clinical importance. Pain was in the category of moderate clinical importance category (30 – 49% improvement).
Comparison of Alpha-Stim Medication and No Medication Groups
The Alpha-Stim only no medication group perceived improvement scores ranged from 9% to 55% higher (See red bar, Figure 10) than the scores for individuals in the Alpha-Stim Medication group across the variables. The most striking finding was on the headache variable. One hundred percent (100%) of the Alpha-Stim only no medication group rated their improvement from using Alpha-Stim as fair, moderate or marked improvement compared to 45.3% of those subjects in the Alpha-Stim medication group for the same categories.
Figure 10. Comparison of Alpha-Stim only no medication and Alpha-Stim medication groups.
Discussion
It is not surprising that the response rate to the survey was not higher. The majority of persons asked to participate in the survey were Active Duty Service Members. Many may not have had access to e-mail as they could have been deployed, in hospitals or rehab centers or too ill to respond. This survey strongly supports the effectiveness and safety of Alpha-Stim technology for the treatment of anxiety, PTSD, insomnia, depression, pain, and headaches in Service Members and Veterans. These findings are consistent with the findings of over 48 clinical and mechanistic research studies on Alpha-Stim technology (Electromedical Products International, Inc., 2011a). The effectiveness of Alpha-Stim technology in a military population was comparable to the effectiveness of the most common drugs used in the treatment of the same
conditions in a civilian population.
Ninety-nine percent (99%) of subjects in this survey considered Alpha-Stim technology to be safe. Alpha-Stim has an excellent safety profile; side effects if they do occur are mild. Side effects (all less than 1%) that have been reported with CES include dizziness, skin irritation at electrode site, and headaches (Alpha-Stim safety and effectiveness data submitted to FDA, 2011). Headaches and dizziness are usually associated with the intensity of current being too high for the individual. These symptoms will resolve when the current is decreased. Irritation at the electrode site can be decreased by using alternate sites for placement of electrodes (Electromedical Products International, Inc. 2011b). Alpha-Stim is FDA leared and during 30 years on the market, there has been no serious adverse effects reported from using Alpha-Stim (Alpha-Stim safety and effectiveness data submitted to FDA, 2011). A huge safety benefit of Alpha-Stim is that it leaves the user alert and relaxed after treatment Kennerly, R.C., 2005) in contrast to drugs that can have serious adverse side effects and that can hamper Service Members ability to function (Tilgman and McGerry, 2010).
The importance of controlling for medication in future studies of Alpha-Stim technology is a valuable outcome of this survey. It would also be helpful to classify the severity of illness of the subjects in future studies. While it appears that medication may influence the effectiveness of Alpha-Stim technology, it could also be that the subjects who were taking prescription medication were a much sicker group that the no medication group. The groups were uneven and the Alpha-Stim only no medication group was considerably smaller ranging from 13 – 26 subjects than the Alpha-Stim medication group that ranged from 53 – 88 subjects. This could possibly account for the differences in scores between the groups. However, the impact of medication appears to be an important confounding variable when investigating Alpha-Stim technology. Examination of the effect of medication on improvement from using Alpha-Stim is an area that requires investigation in a randomized, controlled clinical trial. In conclusion, the results of this survey are compelling and provide the foundation for a rigorous research study that investigates Service Members and Veterans use of Alpha-Stim technology.
References
Alpha-Stim safety and effectiveness data submitted by Electromedical Products, Inc. to the FDA, 2011.
American Educational Research Association, American Psychological Association, National Council on Measurement in Education (1999). Standards for educational and psychological testing. Washington, D.C.: American Psychological Association.
Czaja, R., & Blair, J. (2005). Designing surveys: A guide to decisions and procedures . 2nd ed. Thousand Oaks, CA: Pine Forge Press
Dillman, D. (2007). Mail and Internet surveys (2nd Edition). Hoboken, New Jersey: John Wiley & Sons.
Dworkin, R.H., Turk. D.C., Wyrwich, K.W., Beaton, D., Cleeland, C.S., & Farrar, J.T., et. al. (2008). Interpreting the clinical importance of treatment outcomes in chronic pain clinical trials IMMPAC recommendations. Journal of Pain, 9 (2), 103-121.
Electromedical Products International, Inc. (2011a) Alpha-Stim Bibliography, www.alpha-stim.com.
Electromedical Products International, Inc. (2011b). Alpha-Stim Owner’s Manual.
Goldberg, M.S. (December 17, 2007). Congressional Budget Office Testimony before the Committee on Veterans’ Affairs U.S. House of
Representatives. Projecting the Costs to Care for Veterans of U.S. Military Operations in Iraq and Afghanistan. http://www.cbo.gov/doc.cfm?index=8710&type=0. Accessed on November 1, 2011.
Kennerly, R. C., (2006). Changes in quantitative EEG and low resolution tomography following cranial electrical stimulation. Doctoral
Dissertation, the University of North Texas.
Kessler, R.C., Berglund, P., Delmer, O., Jin, R., Merikangas, K.R., & Walters, E.E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6): 593-602.
Luxton, D.D., Greenburg, D. and Ryan, J., Niven, A., Wheeler, G., & Mysliwiec, V. (2011). Prevalence and impact of Short Sleep Duration in redeployed OIF Soldiers, Sleep, 34 (09), http://www.journalsleep.org/ViewAbstract.aspx?pid=28250.
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Ram, S., Seirawan, H., Kumar, S.K., & Clark, G. T. (February 14, 2010). Prevalence and impact of sleep disorders and sleep habits
in the United States. Sleep Breath. 2(1):63- 70. Epub 2009 Jul 24.
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dangers. Army Times, Accessed on 12/1/2011.
WebMD Pharmaceutical Survey Data from: www.webmd.com/drugs. Accessed on October 28, 2011.
Appendix A
Survey
You were prescribed an Alpha-Stim. Please take just a few minutes to complete this survey to help us learn more so we can better help you and your fellow Service Members and Veterans relieve your mood and sleep problems as well as manage your pain. This information will remain confidential although it may be provided to the government on request in tabular form but your identity will never be revealed.
1. Are you an Active Duty Service Member or Veteran? _________________.
2. What is your diagnosis?
3. Please provide the serial number of the Alpha-Stim unit you use (if you don’t know it or were treated in a medical center please leave this blank and proceed to question 4)________________.
4. What are you using Alpha-Stim for (diagnosis)? _____________________.
5. Are you taking any medication at the same time you are using Alpha-Stim? (yes/no)
6. If yes to question 5, what medications are you taking? _______________.
7. Please list any non-prescription medications or natural products (e.g., herbal or other supplements) you take regularly that are related to the reason you are using Alpha-Stim ______________________________________________.
8. What is your age in years? __________.
9. Do you exercise regularly? (yes/no)
10. If yes to question 9, please state how many days per week, duration per session, and the
type of exercise you do. _________________________________________________________________________.
11. What is your sex? (M/F)
12. Approximately how long have you been using Alpha-Stim? Days ____ Weeks ___ Months _____Years
13. On the days you use Alpha-Stim, how many times per day do you use it? _____________.
14. If you stopped using Alpha-Stim, how long did you use it? Days ____ Weeks ___ Months _____Years
15. If you stopped using Alpha-Stim (question 14), what was the reason? ________________.
16. If you are using Alpha-Stim for your anxiety, since starting Alpha-Stim, rate your improvement as:
a. Worse (negative change)
b. No change (0%)
c. Slight improvement (1 to 24%)
d. Fair improvement (25 to 49%)
e. Moderate improvement (50 to 74%)
f. Marked improvement (75 to 99%)
g. Complete recovery (100%)
17. If you are using Alpha-Stim for your depression, since starting Alpha-Stim, rate your improvement as:
a. Worse (negative change)
b. No change (0%)
c. Slight improvement (1 to 24%)
d. Fair improvement (25 to 49%)
e. Moderate improvement (50 to 74%)
f. Marked improvement (75 to 99%)
g. Complete recovery (100%)
18. If you are using Alpha-Stim for your insomnia, since starting Alpha-Stim, rate your improvement as:
a. Worse (negative change)
b. No change (0%)
c. Slight improvement (1 to 24%)
d. Fair improvement (25 to 49%)
e. Moderate improvement (50 to 74%)
f. Marked improvement (75 to 99%)
g. Complete recovery (100%)
19. If you are using Alpha-Stim for your insomnia, since starting Alpha-Stim, rate your improvement as:
a. Worse (negative change)
b. No change (0%)
c. Slight improvement (1 to 24%)
d. Fair improvement (25 to 49%)
e. Moderate improvement (50 to 74%)
f. Marked improvement (75 to 99%)
g. Complete recovery (100%)
20. If you are using Alpha-Stim for your pain, since starting Alpha-Stim, rate your improvement as:
a. Worse (negative change)
b. No change (0%)
c. Slight improvement (1 to 24%)
d. Fair improvement (25 to 49%)
e. Moderate improvement (50 to 74%)
f. Marked improvement (75 to 99%)
g. Complete recovery (100%)
21. If you are using Alpha-Stim for your headaches, since starting Alpha-Stim, rate your improvement as:
a. Worse (negative change)
b. No change (0%)
c. Slight improvement (1 to 24%)
d. Fair improvement (25 to 49%)
e. Moderate improvement (50 to 74%)
f. Marked improvement (75 to 99%)
g. Complete recovery (100%)
22. If you are using Alpha-Stim for your PTSD,since starting Alpha-Stim, rate your improvement as:
a. Worse (negative change)
b. No change (0%)
c. Slight improvement (1 to 24%)
d. Fair improvement (25 to 49%)
e. Moderate improvement (50 to 74%)
f. Marked improvement (75 to 99%)
g. Complete recovery (100%)
23. Alpha-Stim is more effective than anything else I have used for treatment of my (select only one answer)
a. Anxiety
b. Depression
c. Insomnia
d. Pain
e. Headaches
f. Post Traumatic Stress Disorder
g. Other _________________________.
24. If you selected pain in question 23, list the primary type of pain you are using Alpha-Stim for ____________________.
25. If you selected depression in question 23, are you involved in cognitive behavioral therapy while simultaneously using Alpha-Stim? (yes/no)
26. Do you consider the Alpha-Stim :
a. Safe
b. Safe and effective
c. Unsafe
d. Unsafe and ineffective
27. If you answered unsafe in question 25, please briefly state why. _________________.
