Audio-visual entrainment

1. Introduction

Version followed: audio-visual entrainment (AVE) as described by its developer Dave Siever (Mind Alive Inc., Edmonton, Canada; DAVID device line), in his 2004 article and in Mind Alive operator documentation (DAVID Delight Operator's Manual, v1r0, November 2009; DAVID Premier Quick Start Guide v9). Binaural-beat audio and the separate 40 Hz "gamma sensory stimulation" research line (MIT's Tsai laboratory; Cognito Therapeutics' investigational Spectris device) are covered as related approaches, since clients meet all three under the label "brainwave entrainment". [source: Siever 2004; Mind Alive manuals; The Transmitter 2024]

What it is. AVE presents rhythmic flashes of light (through closed eyelids, via LED glasses) and pulsed tones (through headphones) at a chosen rate. Siever traces it from 19th-century flicker reports (he cites Pierre Janet), Adrian and Matthews' 1934 demonstration that flicker can "drive" the EEG alpha rhythm, and Kroger and Schneider's "Brainwave Synchronizer" strobe for hypnotic induction; he designed the first DAVID device in 1984 and coined the term "audio-visual entrainment". [source: Siever 2004]

Core idea of change, as the developer states it (contested). Siever proposes that the brain's evoked responses follow the stimulus rate ("frequency following"/photic driving) and that sessions induce a "dissociation and restabilization" state with lower muscle tension and skin conductance, warmer hands and slower breathing. He also claims effects on cerebral blood flow, neurotransmitters and EEG "normalisation", and lists uses for relaxation, hypnotic induction, attention problems, seasonal affective disorder, migraine, pain, anxiety, depression and premenstrual symptoms. Much of this rests on his own or unpublished, company-linked work, and some claims (e.g. a link to the "Schumann resonance", dendritic growth) are speculative by his own admission or loosely supported. Treat these as the developer's claims, not established mechanisms. [source: Siever 2004] [uncertain]

Who delivers it and regulatory status. AVE devices are sold directly to consumers and to clinicians; the Mind Alive manual describes the DAVID Delight as non-invasive (no current passed through the user) and for "wellness", and places responsibility for intake on the health care provider when used clinically. No FDA clearance, Health Canada licence or UK/EU medical-device classification for AVE-only devices, and no NICE assessment of AVE or binaural beats, was identified [uncertain: not verified]. Some DAVID models also include cranial electrotherapy stimulation (CES), a separate, contested electrical method with its own warnings (e.g. pacemakers). Spectris (40 Hz light and sound) is an investigational device in Alzheimer's disease trials; the company states it holds FDA Breakthrough Device designation, which is not an approval. [source: Mind Alive manuals; Cognito press release 2 Apr 2025; MedTech Spectrum 2025]

Certification. No dedicated professional credential for AVE was identified. Psychotherapists who want a recognised training route in biofeedback or neurofeedback usually look to BCIA certification, but whether BCIA blueprints cover AVE is not verified [uncertain]. Device training is offered by manufacturers; treat it as product training, not a clinical qualification. [synthesis]

Evidence status (as of October 2026, per the sources cited). A 2008 review (Huang and Charyton, Alternative Therapies in Health and Medicine) concluded that brainwave entrainment showed preliminary promise; the University of York's DARE appraisal judged those conclusions "did not appear reliable", citing unassessed study quality and noting one author worked for an entrainment software company. A 2023 systematic review of binaural beats (Ingendoh, Posny and Heine, PLoS ONE) found 5 of 14 EEG studies consistent with entrainment, 8 contradicting it and 1 mixed, calling the results inconsistent. For 40 Hz stimulation in Alzheimer's disease, mouse findings from the Tsai lab (Iaccarino et al., Nature 2016) were not reproduced by Soula et al. (Buzsáki lab, Nature Neuroscience 2023); the OVERTURE feasibility trial missed its primary cognitive endpoint, with the company highlighting brain-volume results; the 670-patient HOPE pivotal trial completed enrolment in 2025, and the company expected topline results in mid-2026. No published HOPE results were identified by October 2026 [uncertain]. [source: DARE record; Ingendoh et al. 2023 via NeuInfo; The Transmitter 2024; Alzforum; Cognito 2025]

2. Framework

AVE is a device-delivered method rather than a psychotherapy. The developer documentation gives a simple session sequence rather than a phased treatment model; the clinical phases below wrap that sequence in standard psychotherapeutic care. Mind Alive's manual, in the parts cited, does not prescribe a course length for clinical use, and this guide gives no session-dose numbers. [source: Mind Alive Delight manual] [synthesis for phases]

Screening and decision (1 session, may be within routine assessment). Goal: decide whether AVE is safe and appropriate, or whether the client should be steered away from it. Covers seizure and photosensitivity history, brain injury, psychiatric diagnoses, medicines and recreational drugs or alcohol, trauma history, and the client's expectations from marketing. Move on only if no contraindication applies, or if a physician qualified to detect seizures agrees to supervise, as the manufacturer requires for seizure history. [source: Mind Alive Delight manual; Premier Quick Start v9] [synthesis]
Informed consent and expectation setting. Goal: an accurate picture of what the device does, what is claimed, what is contested, possible reactions (memory surfacing, disorientation, nausea, headache, light-headedness on standing) and the right to stop at any time. Move on when the client can explain these back. [synthesis, drawing on the manual's listed reactions]
Supervised introduction (first sessions in the consulting room). Goal: observe the client's response in a dark, quiet setting, seated or reclined, eyes closed, glasses and headphones on, with the device's gradual fade-out at the end and a slow return to standing. The manual advises new users to start at low brightness. Move on (to continued in-session or home use) only if the client tolerated it without seizure-like signs, dissociation that is hard to recover from, or distressing intrusions. [source: Mind Alive Delight manual] [synthesis for criteria]
Integration with therapy goals. Goal: use any relaxation or altered state as one tool within an established therapy (e.g. relaxation training, hypnosis, anxiety work), with monitoring through ordinary outcome measures and session review. Siever describes pairing AVE with hypnotic suggestion, live or recorded. [source: Siever 2004] [synthesis]
Review and ending. Goal: judge on the client's own outcomes whether AVE is adding anything; stop if not, or if adverse effects appear; plan how the client will keep skills (breathing, self-hypnosis, relaxation) without the device. [synthesis]

For 40 Hz gamma stimulation and Spectris, there is no psychotherapist-delivered framework: it is an investigational medical device used within trials. The therapist's role is psychoeducation, supporting decisions about trial participation and routing questions to the research team or physician. [source: Cognito 2025; MedTech Spectrum 2025] [synthesis]

3. Guiding principles

Screen before light. Never start a light-flicker session without a seizure and photosensitivity history; one practical meaning: ask the questions every time, including about family history and past faints or "funny turns", and do not rely on the client knowing they are photosensitive. [source: Mind Alive manuals; Epilepsy Society 2023] [synthesis]
Supervision by the right professional. For any seizure history the manufacturer requires supervision by a provider qualified in detecting seizures; practical meaning: a psychotherapist is usually not that person, so refer to the physician or do not proceed. [source: Mind Alive Delight manual]
Attribute every claim. Practical meaning: say "the manufacturer states…" or "one review found…", never "this will raise serotonin" or "this treats ADHD". [source: DARE record; Ingendoh et al. 2023] [synthesis]
No device settings from the therapist's chair beyond the maker's own instructions. Practical meaning: use only the manufacturer's preset sessions and documentation, do not design custom frequency protocols, and do not advise clients on settings for home use. [synthesis]
Altered states can open trauma material. The manual warns sessions "can cause the release of suppressed memories"; practical meaning: have a containment plan and stabilisation skills in place first with trauma clients. [source: Mind Alive Delight manual]
Adjunct, not treatment. Practical meaning: AVE never replaces an evidence-based psychological or medical treatment, and stopping or delaying such treatment for a device is a red flag. [synthesis]
Client choice and stopping rights. Practical meaning: the client controls the off switch; any wish to stop is followed at once, with the fade-out. [source: Mind Alive Delight manual describes early-stop fade-out] [synthesis]
Stay within competence and scope. Practical meaning: combining AVE with EMDR or CES features on some devices requires separate training and, for CES, its own risk check (the quick start guide says EMDR sessions are for use with a qualified therapist). [source: Premier Quick Start v9] [synthesis]
Commercial neutrality. Practical meaning: declare any financial tie to a device seller and do not sell devices to clients you treat. [synthesis]
Medical questions go to the medical team. Practical meaning: dementia, epilepsy, medicine effects and trial eligibility are discussed with the physician, not decided in therapy. [synthesis]

4. Intervention inventory

Part A describes the methods as developers and researchers publish them, at a descriptive level only (no settings, rates beyond naming what studies examined, or session doses). Part B is the psychotherapist's own work around them.

A1. AVE device session as the manufacturer describes it

Purpose: the manufacturer markets sessions for relaxation, mood, sleep and "brain performance", and its manual claims clinical research support for cognitive decline, attention problems, seasonal affective disorder, depressed mood, insomnia and anxiety. These are manufacturer claims; the DARE appraisal and the 2023 binaural-beat review do not support confident efficacy statements. [source: Premier Quick Start v9; Delight manual; DARE record]
Steps (as published, descriptive): a comfortable, dark, quiet place without interruption; the user sits or reclines; headphones and LED eyeset glasses on; eyes closed; a preset session is chosen from the device's built-in programmes; the session starts after a short delay; it ends with an automatic gradual fade-out (also triggered if stopped early); the user rises slowly. The maker advises low eyeset brightness for new users and drinking water before early sessions to reduce headache or grogginess. [source: Delight manual; Premier Quick Start v9]
Example language (illustrative): "You'll sit back with your eyes closed. You'll see flickering colours through your eyelids and hear soft pulsing tones. You can take the glasses off or press stop at any point, and it will fade out gently."
Watch for: vertigo, nausea, euphoria, déjà vu or a sense of "mental instability" (the manual's list: reduce light and volume or stop); disorientation, nausea or headache on abrupt return to normal awareness (the manual's "somnatic shock", which the fade-out is designed to reduce); light-headedness on standing (orthostatic blood-pressure drop); surfacing of traumatic memories; any seizure-like sign (stop and follow seizure first aid). [source: Delight manual]

A2. Binaural beats and other audio-only entrainment

Purpose: two slightly different tones, one to each ear, create a perceived beat; consumer tracks and apps claim to shift brain states for sleep, focus or mood, or to mimic drugs. [source: Ingendoh et al. 2023; RMIT 2022]
What research examined: EEG changes after listening at various beat rates; the 2023 systematic review found inconsistent effects and very varied methods, and called for standardised research. [source: Ingendoh et al. 2023]
How clients use it: the Global Drug Survey 2021 study (Barratt et al., Drug and Alcohol Review 2022; over 30,000 non-representative respondents in 22 countries) found the commonest reason was relaxation or sleep (72%), then mood change (35%), with 12% seeking psychedelic-like effects; tracks are often named after drugs. Video and streaming platforms were the main source. [source: RMIT 2022]
Example language (illustrative): "Lots of people use those tracks to fall asleep. The research on whether they change brain rhythms is mixed. What have you noticed when you use them?"
Watch for: use to chase altered states alongside drug use; sleep tracks used in place of assessing a sleep problem; distress or dissociation during use. Researchers say safety data are limited. [source: RMIT 2022] [synthesis]

A3. 40 Hz gamma sensory stimulation (research and investigational device)

Purpose: researchers in Li-Huei Tsai's MIT laboratory reported that 40 Hz light flicker reduced amyloid in Alzheimer's model mice (Iaccarino et al., Nature 2016) and later proposed glial and glymphatic mechanisms. Cognito Therapeutics' Spectris headset delivers combined 40 Hz light and sound for daily home use in people with mild to moderate Alzheimer's disease, as an investigational device. [source: The Transmitter 2024; MedTech Spectrum 2025]
Contested status: Soula et al. (Nature Neuroscience 2023, Buzsáki lab) found 40 Hz light did not entrain native gamma oscillations or reliably reduce amyloid in two mouse models; the Tsai group disputed the analysis; a PubPeer thread questioned the statistics of a 2024 Nature paper, which Tsai defended. In humans, OVERTURE missed its primary cognitive endpoint and showed no amyloid change on PET; the company reports brain-volume and EEG correlations as positive signals, including press-released data not stated to be peer reviewed. The HOPE pivotal trial (670 participants, randomised, double-blind, sham-controlled, with an open-label extension) was expected to report in mid-2026; no results were identified [uncertain]. The company states a Breakthrough Device designation and reports no amyloid-related imaging abnormalities. A separate company, OptoCeutics, sells a light device under "general wellness". [source: The Transmitter 2024; Alzforum; Cognito 2025; MedTech Spectrum 2025]
Example language (illustrative): "This is being tested in a large trial right now. The early results were mixed, and it isn't approved as a treatment. The trial team or your doctor is the best place for questions about whether it's right for your mother."
Watch for: families buying consumer "40 Hz" lights or apps on the strength of trial headlines; hope or despair tied to trial news; photosensitivity screening, which applies here as for any flicker. [synthesis]

B1. Seizure, photosensitivity and contraindication screening

Purpose: the manufacturer warns against AVE with a history of epilepsy, photic epilepsy, any seizure disorder or any past seizure, unless supervised by a provider qualified in safe detection of seizures; it also asks for professional supervision with brain injury or any mental disorder, and warns against use with drugs (prescription or recreational) or excessive alcohol. CES-equipped models must not be used with a pacemaker. [source: Delight manual; Premier Quick Start v9]
Steps: (1) Ask about diagnosed epilepsy, any seizure ever (including febrile or alcohol-withdrawal seizures), faints or unexplained blackouts, and reactions to strobes, flickering screens, sunlight through trees or striped patterns. (2) Ask about family history of epilepsy [synthesis]. (3) Ask about brain injury, migraine (light-triggered migraine is not addressed in the manual; treat as a reason to check with the physician [synthesis]), psychiatric diagnoses including psychosis, bipolar disorder and dissociative disorders, current medicines, alcohol and drug use, pacemaker or implanted devices. (4) Record answers. (5) Any positive seizure answer: do not proceed; refer to the physician; proceed only if a seizure-competent provider agrees to supervise. (6) Psychiatric or brain-injury history: discuss with the treating team before any use. [source: Delight manual] [synthesis]
Background to explain: about 5% of people with epilepsy have photosensitive epilepsy; it is more common in children and young people and less often diagnosed after age 20; EEG with photic stimulation is the diagnostic test; tiredness and stress raise risk. [source: Epilepsy Society 2023]
Example language (illustrative): "Before we go further, I need to ask some safety questions, because flickering light can trigger seizures in a small number of people, sometimes in people who have never had one."
Watch for: minimisation ("just a faint once"), young clients, sleep-deprived clients. If a seizure occurs: stop the device, follow standard seizure first aid and call emergency services as first-aid guidance directs. [synthesis]

B2. Psychoeducation and appraising marketing claims

Purpose: clients arrive with claims from apps, podcasts and device sites (e.g. "biohack your brain", raised neurotransmitters, ADHD or depression treatment). The aim is an accurate, non-shaming picture. [source: Siever 2004; RMIT 2022] [synthesis]
Steps: (1) Ask what the client has read or been told. (2) Separate three things: the experience (often relaxing, sometimes vivid visuals), the claimed mechanism (frequency following, contested), and claimed outcomes (not reliably shown). (3) Name who makes each claim (manufacturer, single study, review). (4) Point out that reviews find inconsistent results and that independent appraisers judged earlier positive conclusions unreliable. (5) Agree what, if anything, the client wants to try and how you will both judge it. [source: DARE record; Ingendoh et al. 2023] [synthesis]
Example language (illustrative): "The company that makes it says it improves mood and sleep. Independent reviewers say the studies so far are too mixed to be sure. Many people find it relaxing, and that alone can be worth something, as long as it doesn't replace what's already helping you."
Watch for: clients stopping medication or therapy because of device claims (route medicine questions to the prescriber); costly purchases under pressure. [synthesis]

B3. Informed consent and shared decision-making

Purpose: consent to an adjunct with contested evidence and known reactions. [synthesis]
Steps: explain what happens in a session, the manufacturer's warnings, the reactions it lists, that evidence is mixed, alternatives (e.g. established relaxation training or the evidence-based treatment for the presenting problem), the right to stop, any financial interest you have, and record consent. [source: Delight manual] [synthesis]
Example language (illustrative): "Possible reactions include feeling dizzy or sick, a headache, feeling light-headed when you stand, or old memories coming up. If any of those happen we stop and talk it through."
Watch for: consent driven by hope after other treatments failed; check the client understands it is optional. [synthesis]

B4. Supervised in-session introduction and observation

Purpose: see how the client responds before any continued or home use. [synthesis; the manual's low-brightness start for new users is the source basis]
Steps: (1) Prepare the room as the manual describes (dark, quiet, seated or reclined). (2) Agree a simple stop signal (raising a hand) as well as the device stop. (3) Use the maker's preset relaxation-type session and its new-user guidance. (4) Stay in the room and observe breathing, colour, movement, facial expression. (5) Let the fade-out complete. (6) Afterward, have the client sit for a short while, then stand slowly. (7) Review: bodily sensations, images, emotions, memories, how alert they feel. [source: Delight manual] [synthesis for steps 2, 4, 7]
Example language (illustrative): "Take your time coming back. Wiggle your fingers, notice the chair under you. When you're ready, open your eyes. What was that like?"
Watch for: rhythmic jerking, staring with unresponsiveness, sudden confusion (stop; seizure first aid); marked dissociation, panic, intrusive images; drowsiness that makes driving home unsafe [synthesis].

B5. Responding to emotional release and memory surfacing

Purpose: the manual warns AVE "can cause the release of suppressed memories" and advises seeking appropriate support. Siever also describes a "dissociative anxiety desensitization" use, citing a study in which anxiety ratings rose during sessions while heart rate fell; treat this as a developer-reported application, not a validated trauma protocol. [source: Delight manual; Siever 2004] [uncertain]
Steps: (1) Stop or let the session fade out. (2) Orient to the present (name the room, the date, feel the feet). (3) Use the client's existing grounding and stabilisation skills. (4) Do not probe for detail or treat the material as verified memory; note it, and decide together whether and when to work with it within the client's trauma treatment plan. (5) Check safety before the client leaves; update the safety plan if needed. [synthesis]
Example language (illustrative): "Something came up that felt very real. We don't need to go into it now. Let's get you fully back here first."
Watch for: false certainty about "recovered" memories; avoid suggestion. With trauma clients, establish stabilisation before trying AVE, or not at all. [synthesis]

B6. Pairing with relaxation training or hypnosis

Purpose: Siever writes that AVE may be used alongside hypnotic suggestions on recordings or live via microphone; its history is linked to hypnotic induction devices. [source: Siever 2004]
Steps: only within your existing hypnosis or relaxation training competence; agree goals and suggestions in advance; keep suggestions simple and client-led; finish with a clear re-alerting; teach the client to reach the same state without the device (breathing, self-hypnosis) so gains do not depend on it. [synthesis]
Example language (illustrative): "While the lights and tones run, I'll guide you through the same calming phrases we practised. Afterwards we'll see if you can get there on your own."
Watch for: over-reliance on the device; deep states in clients with dissociative disorders (check with the treating team first). [synthesis]

B7. Talking about consumer apps, binaural tracks and "digital drugs"

Purpose: many clients use free audio or apps unsupervised. The aim is to understand use and reduce harm, not to forbid. [source: RMIT 2022] [synthesis]
Steps: ask what they use, when, how often, what for and what happens; ask about combining with alcohol or drugs; if they use flicker apps or screen-based strobe content, run the B1 screening questions; suggest checking with the GP if seizure history exists; link sleep use to proper sleep assessment where indicated. [synthesis]
Example language (illustrative): "Some people use these tracks to get a high, some to sleep. Which is it for you, and does anything else go with it, like a drink or a joint?"
Watch for: escalating altered-state seeking; substance-use patterns that need their own assessment. [synthesis]

B8. Supporting clients and families considering 40 Hz trials or products

Purpose: people with Alzheimer's disease and carers may ask about Spectris, trials or consumer "gamma" lights. [source: The Transmitter 2024] [synthesis]
Steps: give the attributed status (investigational; mixed early results; pivotal trial outcome to be checked at the time); separate trial participation (with the research team's consent process and eligibility checks) from buying consumer products; encourage questions to the trial team and physician; attend to caregiver hope, grief and decision strain; support capacity-appropriate involvement of the person with dementia. [source: MedTech Spectrum 2025; Cognito 2025] [synthesis]
Example language (illustrative): "It's natural to want to try everything. Shall we write down your questions for the trial team, so you can weigh this with the full picture?"
Watch for: financial exploitation, guilt in carers who decline, abandonment of established dementia care. [synthesis]

B9. Collaboration, referral and reporting adverse effects

Purpose: AVE falls between wellness and clinical use; safety depends on information reaching the right professional. [synthesis]
Steps: refer to the GP or neurologist for any seizure, suspected seizure or new neurological symptom; inform the psychiatrist or treating team before use with psychosis, bipolar disorder, dissociative disorder or brain injury; ask the prescriber about medicines that may lower seizure threshold rather than judging it yourself; report device problems to the manufacturer and, where a medical device is involved, to the national regulator's adverse-event scheme (e.g. the MHRA Yellow Card in the UK, FDA MedWatch in the US) [uncertain: whether AVE-only devices fall under these schemes was not verified]; document. [source: Delight manual] [synthesis]
Example language (illustrative): "Because you had a seizure as a teenager, I'd like your GP to know before we consider this. Would you be OK with me writing to them?"
Watch for: clients asking you not to tell their doctor; explain why you would not proceed without medical input. [synthesis]

B10. Outcome monitoring, generalisation and ending

Purpose: decide on the client's own data whether AVE adds anything. [synthesis]
Steps: agree a target (e.g. sleep onset, anxiety ratings) and a standard measure before starting; review regularly; record reactions; transfer skills to device-free practice; stop if no benefit or if adverse reactions occur; at ending, summarise what helped and how to continue without the device. [synthesis]
Example language (illustrative): "Your sleep diary hasn't changed much over these weeks. Let's put the device aside and focus on the sleep strategies that have been helping."
Watch for: attributing improvement to the device when therapy or time explain it; sunk-cost reluctance after buying a device. [synthesis]

5. Handling problems

The manufacturer's documentation covers physical reactions and memory surfacing; most other guidance below is [synthesis].

Physical discomfort during a session (vertigo, nausea, euphoria, déjà vu, a sense of instability): the manual advises lowering light and sound intensity or stopping. In therapy, stop rather than adjust if you are unsure, let the fade-out run and review. [source: Delight manual]
Headache, grogginess, disorientation afterward: the manual links this partly to abrupt return to normal awareness and to hydration; allow the full fade-out, a recovery period and slow standing; do not let a drowsy client drive. [source: Delight manual] [synthesis on driving]
Suspected seizure: stop the device at once, follow seizure first aid, call emergency services as first-aid guidance directs, do not restart, and refer for medical assessment. Teach that covering one eye fully is the Epilepsy Society's advice on sudden exposure to a trigger. [source: Epilepsy Society 2023] [synthesis]
Overwhelm, panic or dissociation: stop, ground, use stabilisation skills, check safety; review whether AVE suits this client at all. For trauma or dissociative presentations, prioritise the established trauma treatment and stabilisation over device use. [source: Delight manual on memory release] [synthesis]
"Stuck" or no benefit: review the agreed outcome measure; if unchanged, say so and stop rather than adding sessions; return to the evidence-based treatment for the problem. [synthesis]
Client insists on device use despite contraindication: explain the manufacturer's own warning and the need for a seizure-competent supervising provider; decline in-session use; record; offer to share information with their doctor; keep the alliance by working on what the device was meant to help with. [source: Delight manual] [synthesis]
Non-adherence or erratic home use: explore what gets in the way; if home use is not agreed or safe, do not chase it; skills that work without the device are a better target. [synthesis]
Over-reliance or compulsive use (including altered-state seeking with binaural tracks): treat as a behaviour to understand; assess substance use; agree limits or a pause; watch for avoidance of feelings through repeated sessions. [source: RMIT 2022 on motives] [synthesis]
Rupture over evidence ("you don't believe it works"): acknowledge the client's experience as real, separate experience from claims, and keep the conversation curious; avoid dismissive language about the client's purchase. [synthesis]
Rupture over refusal to use it: explain your safety and competence reasons plainly and invite the client to bring the question to their physician. [synthesis]
Medication questions ("can I stop my antidepressant now I have the device?"): do not advise; route to the prescriber, and explore the hope and worries behind the question. [synthesis]
Dementia and carers: when hope rests on a trial or product, help the family plan for both possible outcomes; respect the person with dementia's preferences and involve them as their capacity allows; do not take a position on trial eligibility. [synthesis]
Commercial pressure: if a client is being sold devices, programmes or "protocols" at high cost on medical claims, help them check who makes the claims and talk to their doctor before buying. [synthesis]
Combination devices: if a device also offers CES or EMDR-style bilateral stimulation, treat each as a separate method with its own training and warnings (e.g. CES and pacemakers). [source: Premier Quick Start v9] [synthesis]
DIY or home-made flicker setups (screens, strobe apps): the screening concerns apply in full, and screen-based flicker is a known photosensitive trigger; discourage unsupervised improvised use in anyone with seizure risk factors. [source: Epilepsy Society 2023] [synthesis]

Sources

Online sources:

Cited, not verified in full [uncertain]:

Huang, T. L., & Charyton, C. (2008). A comprehensive review of the psychological effects of brainwave entrainment. Alternative Therapies in Health and Medicine (volume and pages not verified) [uncertain].
Iaccarino, H. F., et al. (2016). Nature (40 Hz light flicker in mice; known here only through The Transmitter's account) [uncertain].
Soula, M., Martín-Ávila, A., Zhang, Y., Dhingra, A., Nitzan, N., Sadowski, M. J., Gan, W.-B., & Buzsáki, G. (2023). Forty-hertz light stimulation does not entrain native gamma oscillations in Alzheimer's disease model mice. Nature Neuroscience, 26(4), 570–578.
Barratt, M. J., Maddox, A., Smith, N., Davis, J. L., Goold, L., Winstock, A. R., & Ferris, J. A. (2022). Who uses digital drugs? An international survey of "binaural beat" consumers. Drug and Alcohol Review (volume and pages not verified) [uncertain].
HOPE trial registry record NCT05637801 (ClinicalTrials.gov) not verified; trial details are taken from company and trade-press reports [uncertain].

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