Anxiety

Calm at 7 Beats-Per-Second

In this video, I play my Gonga drum at 7 beats-per-second to create calm. This tempo results in a more meditative calm than the regular 8 beats-per-second pace I use for my clinical REI music.

You can watch this video where I play at 8 beats-per-second to compare the two tempos at https://www.stronginstitute.com/calm-your-anxiety/

If you want to play at 7 beats-per-second, set your metronome to 105 beats per minute and play 4 drumbeats for each metronome click.

Learn more about my auditory brain stimulation programs athttps://www.stronginstitute.com/rei-custom-program/

Learn how to use techniques like these in my Drum Healing course at https://www.stronginstitute.com/training-courses/drum-healing-course/

Calm with an Udu drum

In this video, I play a claypot Udu drum to calm your nervous system. The sound of this drum is much sharper than the soft, rounded tone of the Gonga drum that I most often play, but the rhythms will still calm you.

If you wish, compare the calming effects of this Udu track with a recent track I played on the Gonga at: https://www.stronginstitute.com/calm-your-anxiety/

Learn more about my auditory brain stimulation programs athttps://www.stronginstitute.com/rei-custom-program/

Learn how to use techniques like these in my Drum Healing course at https://www.stronginstitute.com/training-courses/drum-healing-course/

Listen to my music for free at https://www.brainshiftradio.com

Calm Your Anxiety

This is a classic REI track. It is played at roughly 8 bps (beats per second) and will sink you into an alpha state of consciousness, a relaxed-alert state. Not entirely in 4/4 time, the shifting rhythms and varying time signatures are an intrinsic component of REI content.  

Using REI to Reduce Aggressive Behavior and Anxiety in an Adult with Autism

In this newsletter, I share a case example of one client in the autism spectrum, a 35 year-old male with autism whose main issues were aggressive behavior and anxiety. This example is part of a larger study on adults with autism conducted at a group home setting. You can read the entire study here.

Subject 4: Carl. – Male, age 35.

According to records, Carl had lived in a group home since he was 14 years old. He was placed there due to his family being unable to care for him and to manage his anxiety and aggressive outbursts. This facility was his fifth group home and, due to his volatile behavior, the director reported that she was concerned that he wouldn’t be able to remain in this facility.

The director described that he was responsible for 3-4 violent outbursts each week that resulted in someone begin injured. These were not so seriously as to put anyone in the hospital but significant enough that these incidents needed to be reported to the state agency responsible for the facility’s license. As of the beginning of the REI Study, the facility was under pressure to reduce his aggression or find him a different home that could better manage his behavior. His aggression often manifested when he was directed to perform an activity that he didn’t want to do such as clean up after a horse.

Due to this non-compliance and behavioral reaction, Carl was not involved in many of the day-to-day activities that many of the other residents enjoyed. The staff reported that he did enjoy riding and brushing the horses, but they didn’t allow him to do these activities often due to his tendency to spontaneously hit the horse with a closed fist.

The staff reported that, aside from these aggressive behaviors, Carl’s anxiety also manifested in the form of self-stimulatory vocalizations and sleeplessness. The vocalizations were often threatening. Although he could speak clearly with excellent grammar and vocabulary, he only talked in this aggressive manner.

When I was first introduced to Carl, he went into great detail how he was going to hurt me – punch me in the face, kick me in the groin, elbow me in the chest, for example – if I crossed him. He related this to me at a high volume without making eye contact. By my observation, he didn’t seem like he really intend to do these things because he had the characteristic monotone, lack of eye contact and overall flat affect that characterizes many with autism. He also lacked the usual intensity that typically precedes such an attack. None-the-less, given his history of unprovoked aggression, I was careful not to get too close or to provoke him in any way. I did, however sit down and pick up my drum, which he regarded curiously, and play, which prompted him to sit next to me and touch the drum’s shell. He held onto it as I played with his ear cocked toward the sound. His gaze was unfocused and at no point did he actually look at me.

I played calming type rhythms (at the characteristic REI 8-beats-per-second pace) for a few minutes while he held the drum and quietly sat next to me. After approximately 4 minutes I began a series of more intense rhythms to see if his behavior would change (this is a common approach used by traditional practitioners to invoke a response in a listener and to gauge their level of engagement in the rhythms). Within less than 30 seconds, Carl grabbed the hardware lugs that tension the drum and tried to pull the drum from my lap. Because I have become accustomed to anticipate a reaction of this sort (I’d lost hold of the drum many times before), I pulled back and just barely managed to hang on.

After a short struggle he let go of the drum and leaned back from it, though he stayed in his chair. I began playing it again using the rhythms I started with. He settled down in his chair while I continued playing for another 10 minutes or so. I was careful to not play rhythms that tend to provoke and he noticeably calmed during this time. When I stopped playing, he continued sitting quietly until I left the room.

The staff later reported that Carl remained calm for the rest of the afternoon, until dinnertime when he got into a scuffle with another resident (Subject 3: Billy) over food. Separating Carl and Billy during dinner diffused this incident. The staff noted that an altercation at dinnertime wasn’t unusual and that Carl was obsessive about food, taking as much as he could and eating fast and messily.

One of the other issues that the director related to me with Carl was that he had difficulty sleeping – both with falling asleep and with waking at night. She reported that if not supervised, he would sometimes attempt to leave the facility at night. He liked to wander around outside. On several occasions he was observed walking off the facility grounds and wandering onto neighboring properties. In one case he entered a neighbor’s house. Fortunately, the neighbors knew and recognized him and called the facility director to retrieve him. In order to avert an incident of this sort again, there was a staff member positioned within eyesight of his door throughout the night.

Results after listening to the REI recording

After four weeks of Carl listening to his REI recording once day, met I him in the corral where he was quietly brushing a horse. He had no reaction to me when I approached him – a much different experience for me than the first time I met him, He was clearly calm and focused on rhythmically brushing the horse.

I said hello to him and asked if he remembered me. He responded that I was “that guy with the funny drum” (the drum I use is very usual and shaped unlike any other drum, so this observation intrigued me. Of course it could mean that any drum was funny to him, or my playing was funny, or that he was observant enough to see the drum was different – this would mean he had some previous knowledge of drums and their common shapes. I didn’t explore this with him). I asked if he liked the drumming, to which he simply said, “yeah”. I asked if I could play for him again. His response was, again, simply, “yeah.”

I found a log to sit on about 20 feet away outside of the corral to play and began beating a calming rhythm for him. I noted no discernable response as he continued to brush the horse. After a while I began playing a regular rhythm that employed a steady accented pulse (this rhythm was a traditional Brazilian Samba rhythm with 16th notes playing two quiet notes and two accented notes, with the second accented note louder than the first every-other time through this pattern, making the loud accent occur once every second. This rhythm created a pulsing, forward-moving feel. This rhythm is different from a traditional Samba, however, because every other time through the pattern I cut the rhythm short by two notes, changing the time signature into 7/8, giving the entire rhythm pattern a 15/8 time signature). After a few minutes I noticed that he was brushing the horse to the rhythm, with his stroke following the louder of the accented notes.

I changed rhythms to something more typical of an REI rhythm (more complex and variable) and noticed that his brushing strokes slowly reduce in speed. I stopped playing at approximately 15 minutes, packed up my drum and left. He was still brushing the horse and made no notice of my departure. The staff reported that this was the longest amount of time he’d brushed a horse. They reported that he seemed content to do this. He offered some minor resistance when asked to stop this activity, though didn’t put up a struggle or react aggressively.

The director reported to me with some enthusiasm that they had noted no aggressive incidents from Carl since the first week of his listening to the REI recording. She related that he was much calmer and compliant overall. The staff described that he was more engaged in activities, especially those involving the horses. He hadn’t hit one since beginning listening to the REI recording. He also was more responsive to direction and would stop his vocal stimming when asked. He was still repeating phrases but they were less aggressive in nature.

The staff reported that mealtime was much calmer and noted that his eating had slowed down and he hadn’t gotten into any struggles with other residents over food.

As I instructed, the staff played the recording at bedtime. They noted that he often asked for the recording before going to bed. The tracking notes indicated that he fell asleep much quicker by the second night and was usually asleep by the time the REI recording ended (approximately 20 minutes). The staff noted that he had been sleeping well and hadn’t been observed getting up since then and hadn’t wandered at night. His tendency to wander was still apparent, though, as he did this during the day but he stayed within boundaries of the facility.

The staff also noted that Carl was beginning to engage in conversational speech when prompted. Contrary to what I experienced in my interaction with him at the corral, the staff reported that he was often able to respond with 2-3 sentences to the staff’s questions and directions. He rarely initiated conversations.

After twelve weeks, the facility still reported no incidents of aggression and noted that he was much less aggressive than he was before beginning the study. They described that he was still sleeping well and continuing to show improvements in compliance and listening ability. The director related that mealtimes had become a relaxed time since starting REI and they found that playing a calming REI recording (a precursor to REI Calming Rhythms) reduced anxieties during what used to be a stressful time at bay.

The staff also reported at this twelve-week check-in that Carl’s self-stimulatory vocalizations had decreased significantly. On the occasion that he did engage in these vocalizations, they were no longer aggressive and he would stop when asked. The staff reported that he began initiating conversation with others. This was evidenced by him approaching me and saying, “You’re the drummer guy. Where is your drum?” to me when I arrived for this visit. I answered that I didn’t bring my drum this time and would he like it if I brought it next time. He said, simply “Yeah”.

After 6 months the facility director reported that Carl continued to listen to his REI recording every day and requested it when the staff forgot to turn it on.  He still hadn’t exhibited any aggressive behavior since the first week of beginning REI. Tracking notes indicated that he was still sleeping well and hadn’t gotten up in the night. The staff reported that he was much more pleasant to be around and continued to enjoy his horse-relate activities without incident.

C.ick here for more information on the REI Custom Program

REI for Calm: 3 clinical studies show reductions in anxiety and anxiety-based behaviors

Since our first clinical study in 1994, we have focused on how to reduce anxiety and induce calm. For ten years our research examined children and adults on the autism spectrum. This population proved to be an excellent anxiety-based arena for two reasons:

1. People with autism often have a lot of anxiety. And anxiety can rule much of their behavior. A child may tantrum when asked to enter a noisy, stimulating environment like a restaurant or shopping mall (or school lunchroom) or an adult may react aggressively when sharing mealtime with others.

Observing anxiety in people with autism is easy and noticing changes, however small, becomes simple. The cessation of crying in a tantruming child or halting of aggressive behavior in an over-stimulated adult is an obvious measure of a reduction in anxiety.

2. Because autism is characterized by an inability to socially engage in an appropriate manner or an inability to communicate wants or needs, many people with autism have little to no awareness that some music (or other intervention) is going to be calming. And if they have such awareness, many have no idea how to self-regulate to calm on command.

This effectively removes the placebo effect. And because we are not using self-observed changes in anxiety, but instead use behavioral measures, we further remove any effects of the participants’ expectation from the studies. Either a tantrum stopped or it didn’t. 

Our First Study Showed Significant Anxiety Reduction

Our first study was conducted in a public school setting with children between 6 and 12 years old. In this study we tracked immediate anxiety reducing effects as well as long term changes in anxiety levels. In other words, we wanted to see if listening to REI Rhythms would reduce anxiety as it happened (ending a tantrum, for example) and whether any residual calming effect would result in changes of overall behavior.

Immediate calming effects were significant. Nearly all the participants were calmed most of the time. The average frequency of time calmed by the recordings was 86.4%.

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As far as overall changes in anxiety levels, we also saw significant changes as an average based on the pre and post tests. In the pre-test, average anxiety was listed at 82 on a 100 point scale. Anxiety on average after the study was reduced to 38 on a 100 point scale. This represents a significant reduction in anxiety over this 8-week period when the REI Rhythms were played quietly in the background. (1)

Subsequent Studies Support These Results

Follow-up studies with autism as well as other conditions such as Anxiety Disorders, Attention Deificit Disorders, and Sleep Disorders, showed similar reductions in anxiety while listening to REI music. 

aggression

For example, a study conducted in a residential facility for adults with severe autism showed significant changes in anxiety levels both facility-wide and in individual behavior.

One resident was extremely aggressive before the study began, often injuring other residents or the staff. Before the study, incidents were reported several times per week. Within two weeks of beginning using the REI recording, his agggressive outbursts virtually stopped. And they remained rare for the entire study period and extended follow-up of 6 months. (2)

In another recent study, children within a public school showed significant reduction in anxiety-based behaviors while listening to REI rhythms. This study followed 10 students and showed reductions in behaviors in the following areas:

• Emotional outbursts

• Generalized anxiety

• Self-stimulatory behaviors

• Aggressive behavior

• Sound sensitivity

As the study states: Anxiety reduction can take many forms, especially with the large variation of symptomatic behaviors and characteristics present in children on the autism spectrum. (3)

Rhythmic Entrainment Intervention (REI) Customizes Your Calm

Everyone’s stress and anxiety are different. Some people struggle with the stress of the day while others experience deep-seated anxiety. Because of this we offer several solutions for your calm needs. These include:

Calming Rhythms CD. This CD provides episodic calm. Just turn it on when you need calm; your brain will respond in a few minutes.

Brain Shift Radio. BSR is our personalized streaming music site. Here, you will find episodic relief for your anxiety. Plus, you can mix and match your music to play across the 7 categories of calm, focus, brain boost, uplift, energy, meditation, and sleep.

REI Custom Calm Program. This program is created just for you and will provide long-term improvement in your anxiety and anxiety-based behaviors. 6 custom-made REI tracks are delivered over 6 weeks; we will get to the root of your anxiety.

REI Custom Program. This is our premier, all-inclusive program for long-term improvement. We will make improvements in any combination of 10 symptoms areas you may struggle with, including anxiety. Over the course of 12 custom-created REI tracks, we can address anxiety, attention, cognition, impulsivity, mood, language and communication, social skills, sensory processing, sleep, and self-stimulatory behaviors.

Sources:

1. REI to Calm Autism in Schools

2. REI Rhythms Reduce Aggression in Autism Home

3. Calming Anxiety-based Behaviors in Autism

Case Study: Michael: An 11 year-old with Anxiety, Tics and Sleep Issues

This case study explores Michael’s experience with the REI Custom Program.

Michael is an 11-year-old young man with vocal and motor tics. His vocal tics included grunting and throat-clearing while his motor tics consisted of lip-smacking and picking, neck-rubbing, and finger-bending.

At the beginning of his REI Custom Program, Michael’s tics were present most of time, usually starting just an hour or so after waking in the morning and continuing until bedtime. The degree and intensity of his tics seemed to be related to his anxiety and energy level. If he was tired, he exhibited more tics. Likewise, when he was anxious, his tics were more pronounced.

Aside from his tics, Michael also had difficulty sleeping, both falling asleep and waking at night. Generally it would take him 1 to 2 hours to fall asleep and he would often wake once at night, usually between 3 and 4 am. Most of time he was able to fall back asleep by having a parent lay with him. Other times, approximately 1 or 2 times per week, he would not be able to go back to sleep. Days after this were often times when he his tic behavior was much worse.

Michael also exhibited high levels of anxiety. This was centered around fear of new places, unexpected events, and separation from parents. On a good day he was able to go to school without clinging and displayed only minor trepidation toward new or unexpected situations, such as an unscheduled trip to the store or an event outside his normal routine. His anxiety exhibited itself as clinginess, crying, and tic behavior, most notably vocal tics.

In addition to the tics, anxiety, and sleep issues, Michael also showed classic signs of attention deficit hyperactivity disorder (AD/HD, ADD, ADHD). These symptoms included restlessness, inattention, impulsive behavior, and low frustration tolerance. It is not uncommon for ADHD symptoms and tics to occur at the same time. In fact, many refer to Tourette’s Syndrome (a severe form of tic disorder) as ADHD with tics. In Michael’s case, the tics were very pronounced whereas his ADHD-type symptoms were less significant than is usually the case when tics and ADHD are combined. This was evidenced by the fact that he was not diagnosed with ADHD.

The goal for Michael’s REI Custom Program was to improve his sleep and reduce his tics and anxiety. Additionally, we intended to improve his ADHD symptoms. This was a lot to accomplish with the program, so the key was to prioritize the focus of his program. We decided to focus on his anxiety and sleep first. This is because:

Sleep: Sleep is essential in moderating any of these symptoms, so improving his sleep would likely also improve some of his other symptoms. As well, according to Michael’s intake, his tics were more frequent and intense when he was tired.

Anxiety: Anxiety was a major issue for him in general and also exacerbated his tic behavior. Reducing his anxiety should not only help with the clinginess and crying incidents, but should also help with the tics.

Track #1: Michael began listening to his track at bedtime. The first night he was calmed while the recording played, but he didn’t fall asleep right away. According to his parent’s feedback, he was calm enough that his dad was able to leave room and turn off the light without incident, even though he took a while to fall asleep. This pattern continued for most of his first week. At about day 8 he fell asleep while the recording played and slept through the night.

During this first track Michael exhibited less anxiety over everyday changes, such as going to school or therapy sessions, where he is separated from his mom. His vocal tics were slightly less frequent, while his motor tics remained pretty much the same.

Tracks #2 and #3: These tracks continued to improve his sleep and reduce his anxiety. He was able to consistently fall asleep while the recording played and only woke up two nights. He was able to fall back asleep both nights that he awoke. This was a significant improvement over his historic sleep patterns. His anxiety was better than before the program started, but still manifested as separation anxiety in some situations.

His tic behavior was variable, with some days being better than others. Overall, his vocal tics were less than before the program according to the tracking documents completed by his parents. His motor tics were largely yet unchanged.

Track #4: For most REI Custom Programs there is a significant jump in the stimulation level of Track #4 as we adjust the focus of client’s program. This was the case with Michael. Because he showed improvements in sleep and some changes in anxiety, it was determined that this REI Track would focus more on his tics, particularly the motor tics, which up to this point had only marginally improved.

The first three days went well – his tics, both vocal and motor, decreased significantly in frequency. He had periods during these days when there was no visible tic behavior. Unfortunately on day 4, he began waking up at night again (something he had not done for almost 3 weeks). This trend of improved tic behavior and night-waking continued for the remainder of Track #4 (6 more days).

Track #5: Because of Michael’s change in sleep patterns, we chose to reduce the stimulation level of this track. This was trade-off between his improving tic behavior and his sleep patterns, but it was chosen because good sleep is important not only to functioning well in general but also because his tics often get worse when he is tired. As well, disrupted sleep patterns during the REI Custom Program usually indicate over-stimulation and the best way to counteract this is to reduce the level of the stimulation.

As expected his sleep improved, but also as expected we observed an increase in his motor tics. His vocal tics remained nearly non-existent. His motor tics, though higher than they were toward the end of Track #4, were still below the level that they were at the beginning of the program, so we were encouraged by his overall progress.

Tracks #6 through #8: We continued the dance between uninterrupted sleep and reduced tics during this three-week period. At times his sleep was off (Track #6) while his motor tics abated. And at times his sleep was good but the motor tics increased (Track #7). This was an interesting development because we always felt that good sleep always contributed to fewer tics. The problem was that it appeared that the type of stimulation needed to help with the tic behavior was disrupting his sleep.

By Track #8 we decided to go with the stimulation that would help with the tics and add a track to play at bedtime for sleep. We asked Michael’s parents to play Track #8 (and the rest of his REI Tracks) during the day and a special REI Program Sleep Track at bedtime. After a few days settling into a schedule that worked – they chose to play the Custom REI Track during breakfast – Michael’s sleep returned to where it was after track #3, with him falling asleep with 30 minutes of turning off the light (and turning on the REI Program Sleep Track) and staying asleep most nights.

Based on his parents’ observations, his motor tics remained somewhat variable, but their frequency overall was down from the beginning of the program. Stressful situations, as expected, increased tic activity. Because his anxiety overall was lower than when he began the program, he seemed to be less bothered by situations that used to be stressful for him. There was no observance of vocal tics during Track #8.

Tracks #9 through #12: Michael’s tic behavior was variable but showed steady progress. The vocal tics were essentially absent and there were longer periods of time with few, if any, motor tics. At one point during this period he caught a cold and his tics increased. They reduced again once his cold was over. This demonstrated more overall improvements but also suggested that stress on his system, both physically and psychologically, still had an impact on his tic behavior.

Michael’s anxiety remained low and his sleep was good, with only the occasional bad night’s sleep. Over the last 6 tracks or so he also improved in some of his ADHD symptoms – he seemed less restless and exhibited a greater ability to handle new situations and life’s frustrations.

The end of the 12-Track program: Michael made significant gains in his sleep, anxiety, and tic behavior during the 12-track program, with minor changes in some of his ADHD-type symptoms.

Sleep: Before beginning the REI Custom Program, he often took 1 to 2 hours to fall asleep. He awoke at night several times per week and many times was unable to fall back asleep again. By the 8th day of the Program, his sleep had improved significantly. This made an impact in many ways, including reducing his tics and lowering his anxiety and frustration intolerance.

Anxiety: At the beginning of the Program, Michael’s day was ruled by anxiety. He was clingy with his mother and fearful of new and unexpected situations and events. Within just a few tracks, his anxiety was noticeably lower. He exhibited less clinginess and became more relaxed in general.

Tics: Before REI, Michael’s tics were near-constant and impacted his life significantly. The vocal tics – grunting and throat-clearing – were especially bothersome because they impacted him negatively in social situations. With these gone and the motor tics much reduced, he is now more comfortable interacting with his peers and is receiving less negative peer attention.

ADHD-type symptoms: Even though the focus of Michael’s REI Custom Program was not directed to his ADHD-type symptoms of restlessness, inattention, impulsivity, and frustration intolerance, he did show some improvements in some areas. As his tics decreased, his restlessness also appeared to reduce. This is likely due to the tic behavior appearing as restlessness or fidgeting.

Michael also showed some improvement in frustration tolerance. This coincided with his improved sleep and reduced anxiety, suggesting that this symptom was caused, at least in part, by his poor sleep and high anxiety levels. Likewise, as his sleep, anxiety, and tic behavior improved, so did his attention. There was no observable change in his impulsivity.

Based on his progress it was decided that Michael continue receiving tracks until there was less variability in his tics and anxiety. We also were ready to begin a more direct focus on his attention and impulsivity.

Case Study: REI for 11 year-old with tics, anxiety, and sleep

Michael is an 11-year-old young man with vocal and motor tics. His vocal tics included grunting and throat-clearing while his motor tics consisted of lip-smacking and picking, neck-rubbing, and finger-bending.

At the beginning of his REI Custom Program, Michael’s tics were present most of time, usually starting just an hour or so after waking in the morning and continuing until bedtime. The degree and intensity of his tics seemed to be related to his anxiety and energy level. If he was tired, he exhibited more tics. Likewise, when he was anxious, his tics were more pronounced.

Aside from his tics, Michael also had difficulty sleeping, both falling asleep and waking at night. Generally, it would take him 1 to 2 hours to fall asleep and he would often wake once at night, usually between 3 and 4 am. Most of the time he was able to fall back asleep by having a parent lay with him. Other times, approximately 1 or 2 times per week, he would not be able to go back to sleep. Days after this were often times when his tic behavior was much worse.

Michael also exhibited high levels of anxiety. This was centered around fear of new places, unexpected events, and separation from parents. On a good day, he was able to go to school without clinging and displayed only minor trepidation toward new or unexpected situations, such as an unscheduled trip to the store or an event outside his normal routine. His anxiety exhibited itself as clinginess, crying, and tic behavior, most notably vocal tics.

In addition to the tics, anxiety, and sleep issues, Michael also showed classic signs of attention deficit hyperactivity disorder (AD/HD, ADD, ADHD). These symptoms included restlessness, inattention, impulsive behavior, and low frustration tolerance. It is not uncommon for ADHD symptoms and tics to occur at the same time. In fact, many refer to Tourette’s Syndrome (a severe form of tic disorder) as ADHD with tics. In Michael’s case, the tics were very pronounced whereas his ADHD-type symptoms were less significant than is usually the case when tics and ADHD are combined. This was evidenced by the fact that he was not diagnosed with ADHD.

The goal for Michael’s REI Custom Program was to improve his sleep and reduce his tics and anxiety. Additionally, we intended to improve his ADHD symptoms. This was a lot to accomplish with the program, so the key was to prioritize the focus of his program. We decided to focus on his anxiety and sleep first. This is because:

Sleep: Sleep is essential in moderating any of these symptoms, so improving his sleep would likely also improve some of his other symptoms. As well, according to Michael’s intake, his tics were more frequent and intense when he was tired.

Anxiety: Anxiety was a major issue for him in general and also exacerbated his tic behavior. Reducing his anxiety should not only help with the clinginess and crying incidents but should also help with the tics.

Track #1: Michael began listening to his track at bedtime. The first night he was calmed while the recording played, but he didn’t fall asleep right away. According to his parent’s feedback, he was calm enough that his dad was able to leave the room and turn off the light without incident, even though he took a while to fall asleep. This pattern continued for most of his first week. At about day 8 he fell asleep while the recording played and slept through the night.

During this first track, Michael exhibited less anxiety over everyday changes, such as going to school or therapy sessions, where he is separated from his mom. His vocal tics were slightly less frequent, while his motor tics remained pretty much the same.

Tracks #2 and #3: These tracks continued to improve his sleep and reduce his anxiety. He was able to consistently fall asleep while the recording played and only woke up two nights. He was able to fall back asleep both nights that he awoke. This was a significant improvement over his historic sleep patterns. His anxiety was better than before the program started but still manifested as separation anxiety in some situations.

His tic behavior was variable, with some days being better than others. Overall, his vocal tics were less than before the program according to the tracking documents completed by his parents. His motor tics were largely yet unchanged.

Track #4: For most REI Custom Programs there is a significant jump in the stimulation level of Track #4 as we adjust the focus of the client’s program. This was the case with Michael. Because he showed improvements in sleep and some changes in anxiety, it was determined that this REI Track would focus more on his tics, particularly the motor tics, which up to this point had only marginally improved.

The first three days went well – his tics, both vocal and motor, decreased significantly in frequency. He had periods during these days when there was no visible tic behavior. Unfortunately on day 4, he began waking up at night again (something he had not done for almost 3 weeks). This trend of improved tic behavior and night-waking continued for the remainder of Track #4 (6 more days).

Track #5: Because of Michael’s change in sleep patterns, we chose to reduce the stimulation level of this track. This was a trade-off between his improving tic behavior and his sleep patterns, but it was chosen because good sleep is important not only to functioning well in general but also because his tics often get worse when he is tired. As well, disrupted sleep patterns during the REI Custom Program usually indicate over-stimulation and the best way to counteract this is to reduce the level of the stimulation.

As expected his sleep improved, but also as expected we observed an increase in his motor tics. His vocal tics remained nearly non-existent. His motor tics, though higher than they were toward the end of Track #4, were still below the level that they were at the beginning of the program, so we were encouraged by his overall progress.

Tracks #6 through #8: We continued the dance between uninterrupted sleep and reduced tics during this three-week period. At times his sleep was off (Track #6) while his motor tics abated. And at times his sleep was good but the motor tics increased (Track #7). This was an interesting development because we always felt that good sleep always contributed to fewer tics. The problem was that it appeared that the type of stimulation needed to help with the tic behavior was disrupting his sleep.

By Track #8 we decided to go with the stimulation that would help with the tics and add a track to play at bedtime for sleep. We asked Michael’s parents to play Track #8 (and the rest of his REI Tracks) during the day and a special REI Program Sleep Track at bedtime. After a few days settling into a schedule that worked – they chose to play the Custom REI Track during breakfast – Michael’s sleep returned to where it was after track #3, with him falling asleep with 30 minutes of turning off the light (and turning on the REI Program Sleep Track) and staying asleep most nights.

Based on his parents’ observations, his motor tics remained somewhat variable, but their frequency overall was down from the beginning of the program. Stressful situations, as expected, increased tic activity. Because his anxiety overall was lower than when he began the program, he seemed to be less bothered by situations that used to be stressful for him. There was no observance of vocal tics during Track #8.

Tracks #9 through #12: Michael’s tic behavior was variable but showed steady progress. The vocal tics were essentially absent and there were longer periods of time with few, if any, motor tics. At one point during this period he caught a cold and his tics increased. They reduced again once his cold was over. This demonstrated more overall improvements but also suggested that stress on his system, both physically and psychologically, still had an impact on his tic behavior.

Michael’s anxiety remained low and his sleep was good, with only the occasional bad night’s sleep. Over the last 6 tracks or so he also improved in some of his ADHD symptoms – he seemed less restless and exhibited a greater ability to handle new situations and life’s frustrations.

The end of the 12-Track program: Michael made significant gains in his sleep, anxiety, and tic behavior during the 12-track program, with minor changes in some of his ADHD-type symptoms.

Sleep: Before beginning the REI Custom Program, he often took 1 to 2 hours to fall asleep. He awoke at night several times per week and many times was unable to fall back asleep again. By the 8th day of the Program, his sleep had improved significantly. This made an impact in many ways, including reducing his tics and lowering his anxiety and frustration intolerance.

Anxiety: At the beginning of the Program, Michael’s day was ruled by anxiety. He was clingy with his mother and fearful of new and unexpected situations and events. Within just a few tracks, his anxiety was noticeably lower. He exhibited less clinginess and became more relaxed in general.

Tics: Before REI, Michael’s tics were near-constant and impacted his life significantly. The vocal tics – grunting and throat-clearing – were especially bothersome because they impacted him negatively in social situations. With these gone and the motor tics much reduced, he is now more comfortable interacting with his peers and is receiving less negative peer attention.

ADHD-type symptoms: Even though the focus of Michael’s REI Custom Program was not directed to his ADHD-type symptoms of restlessness, inattention, impulsivity, and frustration intolerance, he did show some improvements in some areas. As his tics decreased, his restlessness also appeared to reduce. This is likely due to the tic behavior appearing as restlessness or fidgeting.

Michael also showed some improvement in frustration tolerance. This coincided with his improved sleep and reduced anxiety, suggesting that this symptom was caused, at least in part, by his poor sleep and high anxiety levels. Likewise, as his sleep, anxiety, and tic behavior improved, so did his attention. There was no observable change in his impulsivity.

Based on his progress it was decided that Michael continue receiving tracks until there was less variability in his tics and anxiety. We also were ready to begin a more direct focus on his attention and impulsivity.