| eBook |

Neuro-auricular
Modulation for EMDR:
Applications in Phases 1-8

Introduction
Integration
Phase 1
Phase 2
Phase 3
Phase 4
Phase 5
Phase 6
Phase 7
Phase 8

Neuro-auricular Modulation and Electrodermal Activity: An Overview

Neuro-auricular modulation is the alteration of nerve activity through targeted stimulation (i.e. using manual stimulation, transcutaneous electrical nerve stimulation, a needle, or a low-level therapeutic laser). This non-invasive form of neuromodulation is applied to the outer ear with the goal of helping regulate (restore balance) physiological and psychological function. Targets are identified by imbalances in electrodermal activity (EDA) on the microsystem of the outer ear.

EDA is understood as an objective measure of patho-physiological/-psychological disturbance.[1-15] By assessing EDA on the auricular microsystem — the most representative somatotopic projection of neural reflex zones as recognized by the World Health Organization[16] — therapists can efficiently identify, measure, and compare the relative importance of physical and psychological disturbances.[17-28] These disturbances can then be regulated with neuro-auricular modulation.[24-28] The effectiveness of which, in turn, can again be measured by EDA.
Using EDA and neuro-auricular modulation, therapists can resolve 3 key challenges in therapy with greater insight, objective measure, and confidence:

  1. Move Beyond Defense Mechanisms | Whether general resistance to therapy, a lack of necessary dual attention, or even sever dissociation, EDA measures of disruption help the therapist target specific physiological and psychological neural states requiring attention. These dysregulated neural states can then be modulated to support rebalancing and self-regulation.
  2. Insight for More Precise Targeting | Using EDA as an objective measure of the relative importance of underlying issues, therapists can use the auricular microsystem as a dynamic window to the brain to support more precise targeting.
  3. Bypass blocks for improved processing | Neuro-auricular modulation can activate the same mechanisms of action activated by bilateral stimulation (BLS) without the need for pre-frontal cortex involvement.

Description of Integration: Using Auricular Methods Alongside EMDR

Auricular Methods are founded in the medical approach that uses the microsystem of the ear for clinical assessment, based on electrodermal activity (EDA), as well as for treatment of mind and body via neuro-auricular modulation[17-28] — and is used in the advanced practice of Auricular Medicine by over 20,000 medical doctors in Germany, Switzerland and Austria alone, especially in cases of therapy resistance.[26-27] Neuro-auricular modulation techniques (e.g. Auricular Methods) are not meant to change, or replace, any aspect of EMDR practice. Rather, they are presented as an adjunct tool to be used independently yet alongside an EMDR session.

The concept underlying EDA and neuro-auricular modulation for assessment and treatment is based in the central nervous system being at the core of the regulation of energy homeostasis,[29] and that healthy energy homeostasis can become disturbed or blocked by disrupted neural states.[17-28] These concepts align with the Adaptive Information Processing (AIP) model and the use of EMDR to unblock the disrupted neural states of “dysfunctional stored experience.”[32-33] In fact, owing to it basis in the mechanisms of action of bilateral stimulation (BLS), EMDR can also be considered a means of neuromodulation. Neuro-auricular modulation and EMDR share neurological mechanisms of action,[18, 30] however the former does so without the need for pre-frontal cortex involvement — which is why auricular neuromodulation is so effective in priming the autonomic nervous system to receive therapy, even when the challenge of defense mechanisms would otherwise prevent it. And, all the while, the use of clinical devices to measure EDA remains an underutilized opportunity in the field of psychotherapy.

This eBook means to introduce use cases for the application of Auricular Methods without changing any aspect of the 8-phase EMDR approach — just as Auricular Methods are used to improve, but not necessarily change, clinical outcomes in many other fields of practice across healthcare and medical research.

Planning

Auricular Methods can be used in phase 1, and even prior to phase 1, to help...
  • improve client insight
  • show immediate relevant understanding 
  • build trust & rapport


An assessment of the ears of the client by a therapist with simple training in the auricular microsystem (see resources below) offers immediate insights to the dynamic and current brain mapping of the client (as projected onto the microsystem of the ear). This understanding of specific active neural states, and imbalances, has the distinct benefit of quickly and effectively identifying very specific somatic and emotional issues — especially those beyond the consciousness or willingness of the client to address. This immediate connection through understanding of the client is effective in establishing and quickly building trust and rapport in the therapist-client relationship.

Assessment

In phase 3, Auricular Methods can be used to address challenges related to...
• target identification
• targeting precision
• priming related neural pathways
The use of EDA on the auricular microsystem in the assessment phase supports improved insight to address EMDR challenges related to target identification and targeting precision. For target identification in the assessment pahse, EDA and neuro-auricular modulation can be very helpful. Active neural reflex zones on the auricular microsystem help guide assessment. Targets that may otherwise remain “hidden” can be brought into discussion through testing of reflex zones on the ear.[25-27] Active reflex zones on the ear can support the precision and relative importance of the most effective targets. Neuro-auricular modulation of the related reflex zones helps to prime the nervous system, either by bringing up related memories or by rebalancing related neural imbalances. EDA provides insights into neural states that may influence the client's ability to experience adaptive information processing in active EMDR. Therapists can note active points identified on the client's ear by EDA to assist in treatment planning and its alignment with the adaptive information processing model. 

Preparation

In phase 2, Auricular Methods can be used to address challenges related to...
  • regulation & dual attention
  • defense mechanisms
  • resistance to therapy


The use of EDA on the auricular microsystem in the preparation phase supports improved insight to address EMDR challenges related to defense mechanisms (i.e. regulation, dual attention, client resistance to therapy, or even severe dissociation). When it is determined in phase 2 that dual attention is not sufficient enough to begin EMDR, EDA helps identify disturbances to pinpoint specific neural states for neuro-auricular modulation, whereby the neuro-auricular modulation has the benefit of activating the same mechanisms of action found to facilitate associative memory processing and restoration of dual attention through EMDR,[30-31] without the risks of proceeding with EMDR when dissociation is detected, or the possible multi-session delays otherwise needed to help clients regulate enough to start with EMDR therapy. Neuro-auricular modulation helps prime the nervous system and balance mind and body to help move beyond defense mechanisms — whether from resistance in cognitive therapy or dissociation.

Installation

In phase 5, Auricular Methods can be used to address challenges related to...
  • overcoming persistent defense mechanisms
  • processing


Given that Auricular Methods have been applied at the appropriate times when needed — to guide treatment planning, support assessment insights, move beyond defense mechanisms and facilitate processing — the effects of the auricular neuromodulation naturally support phase 5 (installation) because neuro-auricular modulation of active points is in effect a treatment of related conditions (neural states) requiring activation to move beyond the “block.”

Desensitization

In phase 4, Auricular Methods can be used to address challenges related to...
  • looping in BLS
  • clients being “stuck” in processing
  • SUDs not decreasing

The use of EDA on the auricular microsystem in the assessment phase supports improved insight to address EMDR challenges related to looping in BLS, client’s being “stuck” in processing, and/or Subjective Units of Disturbance (SUDs) not decreasing. If, for example, a client begins looping in BLS sets, or is unable to report a decrease in SUDs, then EDA can pinpoint active reflex zones for neuro-auricular modulation to help facilitate processing without the need for pre-frontal cortex involvement. Neuro-auricular modulation assists the therapist to side-step the need for cognitive interviews while aiding an autonomic shift in the client, often quickly bringing clients back to processing and re-engaging the path to adaptive information processing. The ability to access this non-cognitive approach has the major benefit of avoiding the possibility of an otherwise incompleted session. EDA, in essence, can be used as a measure of objective units of disturbance (OUD). Although this measure may or may not have a direct relationship to the SUD measure, it provides an additional point of reference.

Body Scan

In phase 6, Auricular Methods can be used to support...
  • somatic associations
  • somatic release


As in phase 4, neuro-auricular modulation can support processing in phase 6 for further release. For example, previously treated ear points may become active again, and/or can be stimulated to bring neural states closer to homeostasis.

The use of EDA can help put an objective measure on the findings of the body scan. Therapists can check the somatic associations on the auricular microsystem and record the measure for comparison with measurements taken during the assessment phase, identify psychosomatic shifts, and apply auricular neuromodulation to further lower EDA.

Reevaluation

In phase 8, Auricular Methods can be used for...
  • measurement of outcomes
  • supporting documentation
  • guidance for next steps


A record of the active points involved at the beginning of each session, and their relative EDA (or even tenderness based on a pain numerical rating scale/NRS as presented in CIAM training), provides therapists with additional reference for reevaluation.

Closure

In phase 7, Auricular Methods can be used to support...
  • final release
  • mind-body connection
  • neural balance


As in phase 6, neuro-auricular modulation can support processing toward final release and neutral state — especially if there is any lingering agitation or stress. During the closure phase, auricular neuromodulation is especially helpful since, again, it bypasses the need for any pre-frontal cortex involvement.

The use of the auricular microsystem offers clients the opportunity to experience a mind/body connection that is very helpful during closure. Often, when therapists use the auricular microsystem, clients express surprise at the connections between their body and mind, and the plasticity of their nervous system. The experience of this discovery provides a strong sense of hope, and supports a state of balance and safety necessary for closure.
Wonderful work! The EMDR portion of Accessing the Somatic and Emotional Experience is immediately useful and applicable to my EMDR practice.”
Dr. Timothy Rowe, MD
Psychiatrist and Director of Psychiatric Services at St. Christopher’s Inn Addiction Treatment & Recovery Community
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Auricular Methods in Psychology

How to Access the Somatic & Emotional Experience Mapped by the Brain

In this course (1 of 4 in the EMDR bundle) you will discover one of the best tools available to every therapist, the ear! The auricular microsystem is a window to the brain that dynamically presents disrupted neural states. In this course you will learn to read the ear and apply neuromodulation to help restore neurofunctional flow. 
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Neuro-auricular Modulation for EMDR

Move Beyond
Defense Mechanisms

While EMDR is among the main treatments for clients with issues ranging from lack of sufficient dual attention to dissociation,[34-38] these issues remain challenges facing the EMDR therapist.[39-43] Using neuro-auricular methods, therapists can bypass pre-frontal cortex involvement and facilitate the restoration of dual attention and self-regulation[17,19,27,28,44-47] — all while avoiding the risks of proceeding with EMDR when a client is not ready.
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Neuro-auricular Modulation for EMDR

Gain Insight for Target Identification & Priority

Even without cognitive input from the client, active points on the microsystem of the ear, especially limbic system and pain memory points,[27] can be helpful in offering clues to useful targets.
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Neuro-auricular Modulation for EMDR:

Support Processing

In some cases, the client simply is “blocked,” in a “processing loop,” or “resistant” during BLS — no decrease in SUDs. Neuro-auricular modulation helps move beyond client defense mechanisms or other blocks without the need for pre-frontal cortex. It activates the mechanisms of action to support engagement, plasticity, healing and processing.[48-52]

CIAM introduces neuro-auricular modulation
at  EMDRIA Conference

The EMDR International Association (EMDRIA), whose membership practices Eye Movement Desensitization Reprocessing (EMDR), represents leadership in the field of psychology — especially in psychology’s shift from purely cognitive to incorporated somatic approaches. The association comprises forward-thinking professionals in the field of psychology who understand the improvement of psychotherapy outcomes through skilled use of multi-modal approaches.

At the EMDRIA 2021 Virtual Conference, the Canadian Institute of Auricular Medicine (CIAM) shared opportunity for discussion, consultation, and Q&A on neuro-auricular modulation techniques to prime the nervous system to be able to receive therapy. Techniques that also provide objective measures of neural disturbance with insight on the specific neural states that will benefit from modulation — all to help move complex cases forward when preparation, targeting, or processing have otherwise become “stuck.”

EMDRIA attendees amazed!

I am going to start training right away.”

This makes so much sense!”

I have used auricular methods before
and now plan to learn more.”

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See neuro-auricular modulation for EMDR
in actual psychotherapy practice

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How to access the somatic and emotional experience mapped by the brain

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Thank you! We will email on the days these discussions go live — see you soon!
References:
[1] Fang Li, MD, Tian He, MD, Qian Xu, MD, Li-Ting Lin, MD, Hui Li, MD, Yan Liu, MD, Guang-Xia Shi, MD, Cun-Zhi Liu, MD, PhD, What is the Acupoint? A preliminary review of Acupoints, Pain Medicine, Volume 16, Issue 10, October 2015, Pages 1905–1915, https://doi.org/10.1111/pme.12761
[2] Colbert AP, Spaulding KP, Ahn AC, Cutro JA. Clinical utility of electrodermal activity at acupuncture points: a narrative review. Acupunct Med. 2011 Dec;29(4):270-5. doi: 10.1136/acupmed-2011-010021. Epub 2011 Oct 14. PMID: 22002962. 
[3] Borlack RE, Shan S, Zong AM, Khlevner J, Garbers S, Gold MA. Electrodermal Activity of Auricular Acupoints in Pediatric Patients With Functional Abdominal Pain Disorders. J Pediatr Gastroenterol Nutr. 2021 Aug 1;73(2):184-191. doi: 10.1097/MPG.0000000000003137. PMID: 33853109. 
[4] Usichenko TI, Wetzel B, Paul J, Lysenyuk V, Hahnenkamp K, Fleckenstein J. Auricular Acupoints with Reduced Skin Resistance: Detection in Patients Scheduled for Hip Arthroplasty. Med Acupunct. 2018;30(6):308-312. doi:10.1089/acu.2018.1314 
[5] Kim, A.Y., Jang, E.H., Kim, S. et al. Automatic detection of major depressive disorder using electrodermal activity. Sci Rep 8, 17030 (2018). https://doi.org/10.1038/s41598-018-35147-3 
[6] Litwińska-Bołtuć M, Święcicki Ł, Spreco A, Timpka T. Clinical effectiveness of the electrodermal orienting reactivity test for evaluating relapse and recurrence risk in patients hospitalized for depression. BMC Psychiatry. 2021 Feb 10;21(1):88. doi: 10.1186/s12888-021-03088-3. PMID: 33568134; PMCID: PMC7877008.
[7] Bogren L, Bogren IB, Thorell LH. Defense Mechanism Test and electrodermal activity. Percept Mot Skills. 1998 Aug;87(1):279-90. doi: 10.2466/pms.1998.87.1.279. PMID: 9760659. 
[8] Sarchiapone, M., Gramaglia, C., Iosue, M., Carli, V., Mandelli, L., Serretti, A., Marangon, D., & Zeppegno, P. (2018). The association between electrodermal activity (EDA), depression and suicidal behaviour: A systematic review and narrative synthesis. BMC Psychiatry, 18, Article 22. https://doi.org/10.1186/s12888-017-1551-4 
[9] Iacono WG, Lykken DT, Peloquin LJ, Lumry AE, Valentine RH, Tuason VB. Electrodermal Activity in Euthymic Unipolar and Bipolar Affective Disorders: A Possible Marker for Depression. Arch Gen Psychiatry. 1983;40(5):557–565. doi:10.1001/archpsyc.1983.01790050083010 
[10] Zahn TP, Nurnberger JI, Berrettini WH. Electrodermal Activity in Young Adults at Genetic Risk for Affective Disorder. Arch Gen Psychiatry. 1989;46(12):1120–1124. doi:10.1001/archpsyc.1989.01810120062010 
[11] J. Kritikos, G. Tzannetos, C. Zoitaki, S. Poulopoulou and D. Koutsouris, "Anxiety detection from Electrodermal Activity Sensor with movement & interaction during Virtual Reality Simulation," 2019 9th International IEEE/EMBS Conference on Neural Engineering (NER), 2019, pp. 571-576, doi: 10.1109/NER.2019.8717170. 
[12] Greco A, Valenza G, Scilingo EP. Advances in electrodermal activity processing with applications for mental health: From heuristic methods to convex optimization. Advances in Electrodermal Activity Processing with Applications for Mental Health: From Heuristic Methods to Convex Optimization. Springer International Publishing; 2016. 
[13] Valenza, G., & Scilingo, E. P. (Eds.). (2014). Autonomic nervous system dynamics for mood and emotional-state recognition: Significant advances in data acquisition, signal processing and classification. Springer International Publishing. https://doi.org/10.1007/978-3-319-02639-8 
[14] Kushki A, Fairley J, Merja S, King G, Chau T. Comparison of blood volume pulse and skin conductance responses to mental and affective stimuli at different anatomical sites. Physiol Meas. 2011 Oct;32(10):1529-39. doi: 10.1088/0967-3334/32/10/002. Epub 2011 Aug 18. PMID: 21849720; PMCID: PMC5028198. 
[15] Ericsson AD, Pittaway K, Lai R. Electrodermal Analysis: A Scientific Correlation with Pathophysiology. IHT BioScan website. 2003. Accessed February 2022. https://www.ihtbio.com/ResearchStudies/ElectroDermal%20Analysis.pdf 
[16] Shang, C. Mechanism of Acupuncture - Beyond Neurohumoral Theory. Medical Acupuncture Journal. 2000; 11(2), 61-70. http://www.acupuncture.com/education/theory/mechanismacu.htm 
[17] Stanton G. Auriculotherapy in Neurology as an Evidence-Based Medicine: A Brief Overview. Med Acupunct. 2018;30(3):130–132. 
[18] Liebell D. The Science of Auricular Microsystem Acupuncture: Amygdala Function in Psychiatric, Neuromusculoskeletal, and Functional Disorders. Med Acupunct. 2019;31(3):157-163. doi:10.1089/acu.2019.1339 
[19] Alimi D. Medical Auriculotherapy: Scientific Bases, Principals and Therapeutic Strategies.[in French]. Paris: Elsevier–Masson; 2017 
[20] Alimi D, Geissmann A, Gardeur D. Auricular acupuncture stimulation measured on functional magnetic resonance imaging. Med Acupunct. 2002;13(2):18–21 
[21] Alimi D, Geissmann A, Gardeur D, Bahr F. Study in fMRI of the stimulation of the auricular areas of the knee as the French–German and Chinese localizations. J Radiol Photon. 2014;(125):133–141 
[22] Romoli M, Allais G, Airola G, et al. . Ear acupuncture and fMRI: A pilot study for assessing the specificity of auricular points. Neurol Sci. 2014;35(suppl1):189–193 
[23] Yoshida T, Tanaka C, Umeda M, Higuchi T, Fukunaga M, Naruse S. Non-invasive measurement of brain activity using functional MRI: Toward the study of brain response to acupuncture stimulation. Am J Chin Med. 1995;23(3–4):319–325 
[24] Yoshizumi AM, Asis DG, Luz FA. Auricular Chromotherapy in the Treatment of Psychologic Trauma, Phobias, and Panic Disorder. Medical Acupuncture. 2018:30(3), 151–154. https://doi.org/10.1089/acu.2018.1281 
[25] Agnes, Muriel. Auricular Medicine: Window to the Brain. Blurb, 2018 
[26] Strittmatter B. Identifying and Treating Blockages to Healing: New Approaches to Therapy-Resistant Patients. Stuttgart, Germany: Thieme; 2004: V, 128. 
[27] Strittmatter B. Ear Acupuncture: A Precise Pocket Atlas Based on the Works of Nogier/Bahr. Stuttgart, Germany: Thieme; 2011: iii-iv, 240. 
[28] Mercante B, Deriu F, Rangon CM. Auricular Neuromodulation: The Emerging Concept beyond the Stimulation of Vagus and Trigeminal Nerves. Medicines (Basel). 2018;5(1):10. Published 2018 Jan 21. doi:10.3390/medicines5010010 
[29] Luquet, S. "The central nervous system at the core of the regulation of energy homeostasis." Front BioSci School Ed, (2009). https://www.ncbi.nlm.nih.gov/pubmed/19482713 
[30] Landin-Romero R, Moreno-Alcazar A, Pagani M, Amann BL. How Does Eye Movement Desensitization and Reprocessing Therapy Work? A Systematic Review on Suggested Mechanisms of Action. Front Psychol. 2018;9:1395. Published 2018 Aug 13. doi:10.3389/fpsyg.2018.01395 [31] O’Driscoll G. A., Strakowski S. M., Alpert N. M., Matthysse S. W., Rauch S. L., Levy D. L., et al. (1998). Differences in cerebral activation during smooth pursuit and saccadic eye movements using positron-emission tomography. Biol. Psychiatry 44, 685–689. 10.1016/S0006-3223(98)00047-X 
[32] F. Shapiro & M.S. Forrest (2004) EMDR: The Breakthrough Therapy for Anxiety, Stress and Trauma. New York: BasicBooks. http://www.perseusbooksgroup.com/perseus-cgi-bin/display/0-465-04301-1 
[33] Shapiro, F. (2007). EMDR, adaptive information processing, and case conceptualization. Journal of EMDR Practice and Research, 1(2). Open access: https://doi.org/10.1891/1933-3196.1.2.68
[34] Haour F, Dobbelaere E, de Beaurepaire C. Scientific Evaluation of EMDR Psychotherapy for the Treatment of Psychological Trauma Summary: Scientific evaluation of EMDR psychotherapy. L'encephale. 2016 Jun;42(3):284-288. DOI: 10.1016/j.encep.2016.02.012. PMID: 27017321.
[35] Diseth TH, Christie HJ. Trauma-related dissociative (conversion) disorders in children and adolescents--an overview of assessment tools and treatment principles. Nord J Psychiatry. 2005;59(4):278. doi: 10.1080/08039480500213683. PMID: 16195132.
[36] EMDR and Dissociative Disorders. EMDRIA website. 2011. Accessed September 30, 2021. https://www.emdria.org/group/emdr-and-dissociative-disorders/
[37] Bufka, L. Et al. Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder (PTSD) in Adults. American Psychological Association website. February 24, 2017. Accessed September 30, 2021. https://www.apa.org/ptsd-guideline/ptsd.pdf
[38] de Jong, et al. Guidelines for the Management of Conditions Specifically Related to Stress. World Health Organization website. 2013. p37. Accessed September 30, 2021. https://apps.who.int/iris/bitstream/handle/10665/85119/9789241505406_eng.pdf ISBN 978 92 4 150540 6
[39] Hart O, et.al. Dissociation of the Personality and EMDR Therapy in Complex Trauma-Related Disorders: Applications in Phases 2 and 3 Treatment. Journal of EMDR Practice and Research. 2014; 8(1): 33
[40] Forgash C, Knipe J. Integrating EMDR and Ego State Treatment for Clients With Trauma Disorders. Journal of EMDR Practice and Research. 2012; 6(3): 121
[41] Dunne T, Farrell D. An Investigation Into Clinicians’ Experiences of Integrating EMDR Into Their Clinical Practice. Journal of EMDR Practice and Research. 2011; 5(4):177-188. DOI:10.1891/1933-3196.5.4.177
[42] L Royle, & C Kerr. (2010). Integrating EMDR into your practice. New York, NY:Springer Publishing.
[43] Stacy R. 4 Big Challenges for EMDR Therapists — Part 3. Stacy Ruse Counseling Group website. Accessed August 6, 2021. https://stacyrusecounseling.com/emdr-therapy-challenges-part-3/
[44] Shiozawa P, Silva ME, Carvalho TC, et al. Transcutaneous vagus and trigeminal nerve stimulation for neuropsychiatric disorders: a systematic review. Arq Neuropsiquiatr. 2014; 72: 542-7.
[45] Kong J, Fang J, Park J, et al. Treating Depression with Transcutaneous Auricular Vagus Nerve Stimulation: State of the Art and Future Perspectives. Front Psychiatry. 2018; 9: 20.
[46] Fang J, Rong P, Hong Y, Fan Y, Liu J, Wang H, Zhang G, Chen X, Shi S, Wang L, Liu R, Hwang J, Li Z, Tao J, Wang Y, Zhu B, Kong J. Transcutaneous Vagus Nerve Stimulation Modulates Default Mode Network in Major Depressive Disorder. Biological Psychiatry. 2016 Feb 15;79(4):266-73. 
[47] Kurebayashi LF, Turrini RN, Souza TP, Marques CF, Rodrigues RT, Charlesworth K. Auriculotherapy to reduce anxiety and pain in nursing professionals: a randomized clinical trial. Rev Lat Am Enfermagem. 2017;25:e2843. Published 2017 Apr 6. doi:10.1590/1518-8345.1761.2843
[48] Rosenberg S. Accessing the Healing Power of the Vagus Nerve. Berkely, California: North Atlantic Books; 2017:87-93.
[49] Porges, S.W. Dana, D. Clinical Applications of the Polyvagal Theory: The Emergence of Polyvagal-Informed Therapies. New York: WW Norton. 2018: 53, 52
[50] Badran B, Dowdle L, Mithoefer O, Austelle C, McTeague L, George M. Neurophysiologic effects of transcutaneous auricular vagus nerve stimulation (taVNS) via electrical stimulation of the tragus: A concurrent taVNS/fMRI study and review. Brain Stimulation. 2017; 11(3):492-500. DOI: https://doi.org/10.1016/j.brs.2017.12.009
[51] Hays SA. Enhancing Rehabilitative Therapies with Vagus Nerve Stimulation. Neurotherapeutics. 2016;13(2):382-394. doi:10.1007/s13311-015-0417-z
[52] Edgerton R., Gad P. Spinal Cord Injury: Is the vagus nerve our neural connectome? eLife 2018;7:e35592 DOI: 10.7554/eLife.35592