Trial By Error: What Is the Dynamic Neural Retraining System?

By David Tuller, DrPH

The Lightning Process, which I have covered extensively, isn’t the only program out there making big assertions about its impact on how the brain functions. These assertions piggyback on the emerging science of neuroplasticity and related concepts and involve the brain’s capacity to generate new neural pathways when it adapts to changes in stimuli. The existence of that capacity does not mean that an intervention hypothesizing a mechanism by which it is inducing the brain to generate these new neural pathways is in fact inducing the brain to generate new neural pathways.

So caution must be taken when assessing programs that present themselves as involving brain retraining as a treatment for serious illnesses. That includes the program called the Dynamic Neural Retraining System, which is based in Victoria, Canada. It has gained adherents in Canada and elsewhere. On its website, DNRS is described as “a drug-free, step-by-step, intensive limbic rehabilitation program” that is based on “neuroplasticity therapy, which rewires the limbic system to build more functional neural pathways.” People who apply the system can, per the website, “find relief from” the following disorders:

  • Adrenal Fatigue
  • Allergies (pollen, food, perfume, chemical, environmental)
  • Anxiety
  • Arrhythmia
  • Asthma
  • Bacterial overgrowth
  • Body temperature regulation issues (hot or cold)
  • Central Sensitization
  • Chronic Fatigue Syndrome/ Myalgic encephalomyelitis (CFS/ME)
  • Chronic Inflammatory Response Syndrome) CIRS or Mold Illness
  • Constipation / Diarrhea
  • Chronic Pain
  • Cognitive Function – memory or brain fog
  • Depression
  • Dysautonomia
  • Eating disorders
  • Electric Hypersensitivity Syndrome
  • Environmental Illness (EI)
  • Fibromyalgia
  • Food Sensitivities
  • Gulf War Syndrome
  • Headaches
  • Heart Palpitations
  • Heavy Metal Toxicity
  • Insomnia
  • Irritable Bowel Syndrome
  • Lack of sex drive
  • Latent infections
  • Leaky Gut Syndrome
  • Lyme Disease
  • Mast Cell Activation (MCAS)
  • Mold Illness
  • Multiple Chemical Sensitivity
  • Obsessive Compulsive Disorder
  • Pain (chronic)
  • Panic Attacks
  • Poor circulation
  • Post Traumatic Stress Disorder
  • POTS (Postural Orthostatic Tachycardia Syndrome)
  • Sensitivity to smell, taste. light, sound, touch
  • Skin Conditions – eczema, rash, hives
  • SIBO (small intestinal bacterial overgrowth)
  • Tinnitus
  • Thyroid Disorders
  • Vulvodynia

Here’s how DNRS is said to work:

“We directly target brain function and a maladapted stress response that is at the root of suffering for so many. We do not chase your symptoms – we teach you how to change the function and structure of your brain. When you rewire the limbic system, you move your body from a state of survival to a state of growth and repair – where true healing can take place. Find out how it can help you.”

DNRS founder Annie Hopper, a compelling speaker, is not a doctor or a scientist and does not pretend to be. The website identifies her as a “limbic system rehabilitation specialist.” In 2004, according to the website, Hopper was fully engaged as a “core belief counselor, newspaper columnist and talk show guest as an expert in Emotional Wellness.” Then Hopper’s health began to deteriorate, for unknown reasons. As the website explains:

“Mysterious symptoms like insomnia, headaches, body aches and pains, chronic exhaustion and an increasing list of sensitivities ensued. Toxic overload was the eventual diagnosis. But even after undergoing detoxification treatments and an extensive list of healing treatments from over thirty different practitioners, her symptoms continued to escalate.  This was the beginning of what can only be described as a type of science fiction nightmare.  After almost 4 years of suffering that eventually led to homelessness, Hopper deduced that a toxic brain trauma was most likely at the root of her suffering.  Hopper went on to creatively rewire the neural circuits in her brain that had been altered due to toxic trauma and the symptoms of illness eventually dissipated.

In 2008, as a result of her own experiences, Hopper launched DNRS, which offers five-day in-person workshops as well as individual coaching, online courses, access to support groups, and so on.

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Buzzy and evolving constructs

When it comes to DNRS, the Lightning Process, and other adventures in proposed but unproven mechanisms like limbic rewiring, I don’t question anyone’s personal journey or experiences of relief from suffering. People have the right to pursue strategies based on buzzy and evolving understandings, or based on nothing at all. If these programs incorporate such elements as meditation practices, relaxation techniques, positive affirmations, body awareness exercises, psychological counseling and whatever else, they could possibly help reduce stress, enhance feelings of self-confidence, and prompt useful reflection on past and present actions–whether or not limbic rehabilitation has occurred.

Beyond that, such programs can have generalized impacts unrelated to the content. For some, spending time in a group of like-minded people might have an ameliorative effect. In a 2013 critique of “brain retraining” programs like DNRS on the site Science-Based Medicine, Yale neurologist and professional skeptic Steven Novella noted the following: “Just doing something, anything, to address a chronic problem is likely to make someone feel better. In the case of “brain training” interventions, there are real cognitive benefits to the increased mental activity. The problem is the layer of pseudoscience placed on top of this legitimate but limited intervention.”

Whatever their possible benefits, however, these strategies also have possible medical and psychological harms. And they are not evidenced-based treatments for major medical conditions and diseases, no matter how expansive the list on the DNRS website. The site also includes many endorsements from health care professionals and from satisfied customers. These accounts might provide some sense of what the program entails while also serving as marketing tools, but such testimonials do not constitute proof of effectiveness.

The website’s “research” button leads to a page about a single study, which was conducted by investigators at McMaster University in Hamilton, Canada. The page includes a video of a presentation about the study delivered on November 17, 2019, at a major primary care conference in Toronto. The speaker, Dale Guenter, is a family physician, an associate professor at McMaster, and a proponent of therapeutic approaches focused on “retraining the brain”–an approach he outlined in a 2017 talk.

The participants in the study that Guenter presented last November were recruited from among attendees of eight DNRS workshops–five in Canada, two in the US and one in the UK. It was not an experimental study, such as a randomized clinical trial, that would allow investigators to make causal inferences. The study had no control group of patients who did not receive DNRS in order to compare sets of outcomes.

The presentation does not make it clear whether the participants paid for the DNRS program. If they did, as seems likely, that investment could have biased them toward providing more positive assessments; after all, most people prefer not to think they threw money away. Furthermore, the study by its design was capable only of documenting associations. It did not and could not document that the intervention was responsible for any reported changes. To make causal claims based on these data is not justified.

Nevertheless, Guenter introduced his talk on DNRS by noting “how well it worked for the people who were in our study.” At the end, he thanked the audience for “taking the time to learn about how DNRS is working for people.” Whatever enthusiasm he has for DNRS based on his experiences as a clinician, the findings in this study have so many limitations and caveats that they provide little insight about the intervention’s overall impacts–including whether it “worked” as touted.

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So what were the results?

Of 150 DNRS participants, 102 agreed to fill out questionnaires for the research–meaning almost a third declined, for unknown reasons. The respondents were predominantly white women, and the average age was 51. They reported an average of five diagnoses each, with fibromyalgia, chronic fatigue syndrome, multiple chemical sensitivities, depression, and anxiety among the most common. As Guenter himself noted, these diagnoses were not confirmed. Whether they were rendered by a competent clinician or whether patients diagnosed themselves is unknown.

At three months, six months, and 12 months, respectively, the number of participants responding to the questionnaires dropped to 80, 70, and 64. This represents a fairly high rate of what epidemiologists call “loss to follow up.” A significant rate of loss to follow up is not considered a positive endorsement of an intervention, since people who perceived it to be helpful could be considered more likely to respond. When properly accounted for in statistical analyses, a higher drop-out rate can reduce the apparent benefits attributable to an intervention.

The study’s main outcome measure was the SF-36, a quality of life questionnaire with eight sub-scales. One is the physical function sub-scale that is often used in ME/CFS research; other sub-scales focus on mental health, social function, bodily pain, general health and so on. Since these outcomes are subjective and self-reported, they are prone to significant bias and placebo effects, especially given the intervention’s promises of relief from suffering. With no objective measures in the study, the reported findings are difficult to interpret and cannot be called robust.

The mean scores for all eight sub-scales follow a similar path—a major improvement from baseline to three months, with minimal further changes at six and twelve months. The pattern of eight lines trending upwards in tandem looks impressive on a graph, but there is less here than meets the eye. The analysis seems to have involved averaging the scores received from whichever participants submitted them at any given assessment point. If that’s the case, the apparent improvements in scores could be largely or fully an artifact of the drop-outs.

Let’s say the participants who were most impaired at baseline were more likely to drop-out at subsequent points—a reasonable assumption. Let’s say everyone else stayed the same from baseline through 12 months–no worse, but no better. Given that set of facts, the average mean scores calculated from participants who continued to submit data would rise from baseline even though no individual scored any better.

And what if many or most of the 22 participants who were lost to follow up at three months found DNRS not just useless but actually harmful? What if many or most got worse, as some ME patients have reported after going through the Lighting Process?

Demonstrating an improvement in the mean scores of a shrinking pool of participants tells us little if we know nothing about the many who dropped out. In any event, an improvement in mean scores can be influenced by outliers and reveals nothing about how many individuals improved their scores, and by how much. Perhaps the investigators have individual-level data that would indicate actual improvement in a significant number of individuals. If so, they should share these data as well.

Guenter acknowledged that a trial with a control group would provide more robust information, as would the development of biomarkers to measure the hypothesized changes. All true.

Until then, does this presentation really demonstrate that DNRS “is working for people”? No. Does that mean people shouldn’t do it? That’s not my call.

Comments on this entry are closed.

  • jen 2 September 2020, 10:10 pm

    great evaluation, thanks

  • Alicia Butcher Ehrhardt, PhD 2 September 2020, 10:17 pm

    If these interventions worked, we’d know.

    I’ve seldom met a more committed, knowledgeable, determined group of people than others who have had the same thing (ME/CFS – or call it what you like) for decades.

    We’d proclaim it from the rooftops. There would be no problem with getting insurance to pay for it, or national health services. Those who have children that are sick would demand – and get it – for their kids.

    My call: prove it to me with properly controlled scientific trials with SIGNIFICANT improvements. That last.

    It would not be difficult to get people to keep giving feedback if it worked. Ergo, it doesn’t.

  • robert christ 3 September 2020, 12:29 am

    Dr Novella does a blog called neurologica also. Very good!
    https://theness.com/neurologicablog/

  • CT 3 September 2020, 1:31 am

    It seems that participants in the DNRS study had no direct medical assessment and their past medical records/assessments and test results weren’t used either so presumably they just told the researchers that they had x, y or z condition. It might have been useful if the researchers had investigated how many of the participants reported having been given a clinical diagnosis, but did they? Perhaps the paper will tell us, if and when it’s published.

    It really irritates me when studies like this one report the mean age of participants (in this case 51.4 with a range of 20 – 78) instead of reporting the modal group. Do they want readers to think that people with these complaints are mainly menopausal women? (It could be that there was quite an even distribution over the age range with a few extra in the elderly bracket pushing the mean up a bit from 49 to 51.4).

  • Lisa Petrison, Ph.D. 3 September 2020, 9:17 am

    Erik Johnson, who is a survivor of the 1980’s Tahoe epidemic of the disease now called ME/CFS, and I have both been outspoken in our criticisms of so-called “brain retraining” programs such as DNRS.

    Despite (or possibly because of) that, Hopper’s organization published this page on ME/CFS, which quoted Erik and linked to a page on my Paradigm Change website.

    https://retrainingthebrain.com/understatement-chronic-fatigue-syndrome/

    My feeling is that this page implies that Erik and I are endorsing the program and thus is misleading to people.

    I wrote a civil comment pointing this out on the DNRS Facebook post promoting the website page, and the organization promptly removed the comment.

    My similar civil comment on the page itself never was approved.

    I feel that this occurrence (like many others that I have witnessed) suggests that this company is not making an effort to pursue ethical business practices, and that this is an additional problem to the issues mentioned in the article above.

    Thank you for writing the article, David.

  • SusanC 3 September 2020, 11:17 am

    A friend of mine happened to mention that she is still suffering after effects from the 1957 flu pandemic (permanent lung damage).

    We know serious that cases of flu can cause permanent respiratory damage, such that patients who came down with flu as children in 1957 still have symptoms today.

    It would seem a reasonable hypothesis that, similarly, some covid-19 patients will be still having respiratory problems decades from now.

    If someone is doing experimental eval of therapies for covid-19 after effects, some account should be taken of permanent physical lung damage (which CBT is unlikely to fix) versus PTSD symptoms with the viral infection being the initial trauma which triggered the PTSD (for which CBT might conceivably be effective)

    The long list of conditions for which “Dynamic Neural Retraning” is listed as a therapy above are mostly (with some notable exceptions) variations on the theme of the PTSD/anxiety disorders that CBT was designed to treat. So it’s just about plausible that one therapy might work for that subset, as they’re all related conditions.

    On the other hand, if the patient’s difficulty with strenuous exercise is because they’ve lost lung capacity (or damage to the heart muscles, etc). CBT (or variants thereof) is unlikely to cure it.

  • Benjamin Blumberg, PhD 4 September 2020, 9:05 am

    I have long thought that a treatment like DNRS might be able to counter the miswiring involved in autism, but I saw no mention of autism among the conditions listed above. I wonder why not?

  • Richard Smallfield 5 September 2020, 8:24 am

    Thank you so much David. Your thoughts echo mine. Big claims – without hard evidence.

  • Art Vandelay 14 September 2020, 2:35 am

    Thank you for looking into this, David. I’ve noticed an upsurge in interest from ME patients in this program (along with other dubious treatments such as the Gupta Program and ANS rewiring).

    Hopefully your investigations will prevent some patients from wasting their money on these scams.

  • Laurie Smith 20 September 2020, 4:54 pm

    Lack of scientific evidence doesn’t make something a scam, a some commenters say and imply. Good studies cost a lot of money, and conditions such as MCS and CIRS don’t get funding for many reasons I won’t go into here, not the least of which is no common etiology. So most studies on this sort of thing end up getting crowd-sourced, or are industry funded. Tricky.

    And I find curious what one commenter says about how people with ME/CFS would be screaming from the rooftops ‘if it worked’ . I know many people with those conditions who do indeed scream from the rooftops about their results. I watched one of them go from 2 functional hours of energy a day to pretty much fully functional in one year’s time.

    I do agree that there are ethical issues with the DNRS business model and approach to dealing with critical commentary.

    I myself got 70% better from using brain retraining programs. Most of the improvement came in the first 4 months. I had severe mold issues, CIRS and MCS to the point where I could only go out in public in a contractor’s respirator mask.

    There is currently a study underway that addresses some of the bias’ this author points up in the McMaster study. But that study too is underfunded and only a pilot.

    I would strongly recommend a brain retraining program to sufferers. I’m curious to see what the data shows that comes out of the current study.