Binaural-beat entrainment

1. Introduction

Version followed: the research protocols for binaural auditory beat stimulation as summarised by Chaieb et al. (2015) and the Garcia-Argibay et al. (2019) meta-analysis, plus the procedural-anxiety trial registrations opened (University of Miami PACU trial NCT07437469; Shiraz nuclear-imaging trial IRCT20140514017684N9; Ankara endoscopy RCT NCT06114524). Commercial programmes (Hemi-Sync and its Gateway courses) are covered in tab 089 Hemi-Sync and are not repeated here.

What it is. Binaural-beat entrainment is an audio technique, not a psychotherapy with a founder or treatment manual. Each ear hears a pure tone of slightly different frequency through headphones; the listener perceives a third, pulsing "beat" at the difference frequency (e.g. 400 Hz left and 440 Hz right give a 40 Hz beat), heard as located inside the head. Dove described the phenomenon in 1839 and Oster gave the classic account in 1973. The percept is generated centrally, most likely in the superior olivary complex of the brainstem, and is only heard with carrier tones below roughly 1000 Hz. Monaural beats (two tones mixed before reaching both ears) are a physical, peripheral variant that produces stronger cortical responses. [source: Chaieb et al. 2015]

Core idea of how change happens. The working hypothesis is that rhythmic auditory input entrains cortical oscillations (described in the literature as the auditory steady-state response or frequency-following response) at the beat frequency, and that shifting the brain toward, e.g., slow delta/theta or alpha activity shifts state: less anxiety, more relaxation, altered attention or recall. Chaieb et al. report anxiety reduction as the most consistently reported effect. Whether EEG entrainment actually occurs is contested in the research literature (Ingendoh et al. 2023 systematic review) [uncertain]. In psychotherapy it is best treated as a low-cost, self-administered relaxation/state-change adjunct, not as a stand-alone treatment. [source: Chaieb et al. 2015; Garcia-Argibay et al. 2019; synthesis for the psychotherapy framing]

Attributed claims. Marketing that sells tracks as "digital drugs" which simulate the effects of MDMA, cannabis or psychedelics, or that promise spiritual awakening, astral projection or chakra activation, are claims of the vendors and users, not established effects. In the Global Drug Survey 2021, 5% of respondents had used binaural beats to reach altered states (72% for relaxation or sleep, 35% to change mood, 12% to get psychedelic-like effects); users were more likely to report recent use of prohibited drugs. [source: RMIT news release on Barratt et al. 2022, Drug and Alcohol Review]

Regulatory status. No source opened describes binaural-beat audio as a regulated medical treatment in any jurisdiction; it is sold freely as consumer audio and apps. [uncertain: regulatory status not verified]

2. Framework

There are no published phases or stages in the sense of a therapy model. The sources describe three use patterns, which a clinician can treat as a simple framework. [source: Chaieb et al. 2015; trial registrations; framework structure is synthesis]

Phase A: Screening and set-up (one session, 10 to 20 min of a normal therapy hour). Goal: rule out exclusions (section 4, Screening), agree the purpose, choose the stimulus and listening conditions, take a baseline rating. Move on when the client has no exclusion, understands that effects are modest and uncertain, and has headphones and a quiet place. [synthesis, using exclusion criteria from the trials]

Phase B: Use pattern (choose one).

Single-episode, situational use before or during a stressful event: 3 to 30 min single sessions in the studies, e.g. 15 min before endoscopy, 20 min in the emergency department, from 3 min before imaging until the scan ends, 30 min on arrival in recovery. [source: Chaieb et al. 2015; NCT06114524 via Demirci & Sezer 2024; IRCT20140514017684N9; NCT07437469]
Daily home programme for ongoing anxiety: e.g. 30 min daily for one month (Le Scouarnec et al., mild anxiety disorders) or 30 min daily for 60 days (Wahbeh et al., delta beats); 20 min daily for three months in a tinnitus study. [source: Chaieb et al. 2015; Prakash & Konadath 2025]
Pre-task priming for attention or creativity: brief exposure (e.g. 3 min) before a task; the meta-analysis found exposure before, or before and during, a task worked better than exposure only during it, and that longer exposure was associated with larger effects. [source: Chaieb et al. 2015; Garcia-Argibay et al. 2019]

Phase C: Review (every 1 to 2 weeks within ordinary therapy sessions). Goal: compare ratings against baseline, check adverse effects, decide to continue, adjust, swap to an alternative (music of choice, standard relaxation training) or stop. Criteria to continue: subjective benefit plus no worsening of mood, sleep or dissociation. Criteria to stop: no benefit after about 2 to 4 weeks of daily use, or any adverse effect listed in section 4. [synthesis; review time points not specified in sources]

3. Guiding principles

It is an adjunct, not the therapy. Use it to lower arousal so the client can engage in the actual work; one line: never let it replace evidence-based treatment for the presenting problem. [synthesis]
Claims are modest and contested. The meta-analysis found a moderate overall effect across memory, attention, anxiety and pain, but EEG entrainment is disputed; tell clients it may help them relax, not that it will "rewire" their brain. [source: Garcia-Argibay et al. 2019; Chaieb et al. 2015]
Purpose determines the frequency band. Studies used delta (about 0 to 4 Hz) and theta for anxiety and relaxation, alpha (about 10 Hz) for anxiety in acute settings, beta (16 to 24 Hz) for vigilance and mood, gamma (40 Hz) for creativity/attention; one line: do not give alerting frequencies at bedtime or slow ones before driving. [source: Chaieb et al. 2015; NCT07437469; Brain.fm safety post for sleep disruption]
Effects can go the wrong way. A single 30-min theta session raised a depression subscale and reduced immediate verbal recall in one study; one line: rate mood before and after, and stop if it dips. [source: Chaieb et al. 2015 citing Wahbeh et al.]
Screen first. Trials excluded hearing impairment, significant tinnitus, epilepsy, arrhythmia, delirium and major psychiatric illness; one line: these clients need medical advice or an alternative. [source: NCT07437469; IRCT20140514017684N9; Prakash & Konadath 2025]
Client controls the stimulus. In the Miami trial participants set their own comfortable volume and could stop at any time; one line: the client holds the off switch. [source: NCT07437469]
Protect hearing. Comfortable, conversational-level volume (the Miami trial used about 55 to 65 dBA). [source: NCT07437469; Brain.fm safety post]
Never while driving or operating machinery. [source: Weil 2012; Brain.fm safety post]
Report and choose parameters transparently. Chaieb et al. urge full reporting of carrier, beat frequency, duration, background noise and timing; one line: write down exactly which track the client uses so you can judge what worked. [source: Chaieb et al. 2015]
Attribute spiritual and drug-like claims. Treat "digital drug", out-of-body or energy claims as the vendor's or the client's beliefs, explored respectfully, never endorsed as fact. [synthesis; see 089 Hemi-Sync]
Harm reduction, not facilitation, when combined with drugs. Many users combine tracks with substances; the clinician's role is assessment and safety planning. [source: RMIT/Barratt et al. 2022; synthesis for clinician role]

4. Intervention inventory

No founder manual exists; the interventions below are the use patterns and procedures found in the studies and trial protocols opened, plus clearly marked clinical adaptations. Section 4.1 (screening) and 4.2 (set-up) apply to all of them.

4.1 Screening and contraindication check

Purpose / when: before any recommendation, in session one of use.
Steps:
1. Ask about exclusions used in the trials: moderate-to-severe hearing impairment or hearing aids; significant tinnitus; active delirium; major psychiatric illness; general anaesthesia context (Miami PACU trial) [source: NCT07437469]; arrhythmia, hearing problems, history of epilepsy (Shiraz imaging trial) [source: IRCT20140514017684N9]; ear, auditory-processing, neurological or degenerative disorders, and psychiatric conditions with related medication (tinnitus study) [source: Prakash & Konadath 2025].
2. Ask about cautions named in practitioner and commercial sources: epilepsy or seizure history, including musicogenic epilepsy (consult a neurologist first; the risk is described as theoretical, with no published cases known to the authors) [source: Brain.fm safety post; Weil 2012]; irregular heartbeat or pacemaker [source: Weil 2012]; sound sensitivity or hyperacusis (start very short and quiet, or skip) [source: Brain.fm safety post].
3. Add clinical cautions not named in the sources [synthesis]: current or past psychosis or bipolar disorder (risk of destabilising altered states, especially with long or trance-oriented tracks); dissociative disorders, depersonalisation, or severe trauma without stabilisation (slow-wave relaxation and inward focus can bring up intrusions); current depression (given the depression-subscale rises reported by Wahbeh et al.); substance use with tracks marketed as "digital drugs". Pregnancy is not named as a contraindication in any source opened [uncertain]; no specific reason to exclude was found.
4. Ask what the client already uses (apps, YouTube tracks, Hemi-Sync, combination with substances) [synthesis; usage patterns from Barratt et al. 2022].
Example language (illustrative): "Before we try this, I need to check a few things that the research studies screened for: any hearing problems, tinnitus, seizures, or heart rhythm problems?"
Watch for: any exclusion means refer for medical advice or choose an alternative (standard relaxation training, music of choice). Document the screen.

4.2 Standard listening set-up

Purpose / when: every use; this is the common frame across protocols.
Steps:
1. Stereo headphones are required for binaural beats, since each ear must receive a different tone; the trials used headphones or over-ear headphones [source: Chaieb et al. 2015 (implied by mechanism); NCT07437469; IRCT20140514017684N9]. If the client cannot use headphones, monaural beats or isochronic audio work over speakers but are a different stimulus [source: Chaieb et al. 2015 for monaural; synthesis for the speaker point].
2. Choose a track whose carrier tones are below about 1000 Hz (lower carriers, e.g. 250 Hz, gave stronger responses; the Miami protocol uses soft sine carriers in the 200 to 600 Hz range) and whose beat frequency matches the purpose (section 3) [source: Chaieb et al. 2015; NCT07437469]. Beats can be pure tones, embedded in music or natural sound (Weiland et al.), or mixed with pink/white noise; masking noise was not necessary for effects in the meta-analysis [source: Chaieb et al. 2015; Garcia-Argibay et al. 2019].
3. Volume: comfortable, conversational level, set by the client; the Miami trial targets about 55 to 65 dBA [source: NCT07437469]. Commercial guidance cites risk rising with sustained exposure around 85 dB and suggests about 60% of maximum with breaks every 60 minutes [source: Brain.fm safety post; attributed, not verified].
4. Quiet setting, seated or lying, not driving or operating machinery [source: Prakash & Konadath 2025; Weil 2012].
5. Tell the client they may stop at any time [source: NCT07437469].
6. Record track name, beat frequency, duration and time of day [source: Chaieb et al. 2015 reporting recommendations; synthesis for clinical recording].
Example language (illustrative): "Put the headphones on, set the volume so it's soft enough you could talk over it, and if anything feels unpleasant, just take them off."
Watch for: headache or pressure, dizziness, nausea, agitation, disorientation (section 4.11).

4.3 Pre-procedure or pre-event anxiolytic listening

Purpose / when: situational anxiety before a medical or dental procedure, scan, exam, presentation, or a feared exposure task. The best-studied use. [source: Chaieb et al. 2015; Demirci & Sezer 2024; Shukla et al. dental meta-analysis summary]
Steps:
1. Screen (4.1) and rate state anxiety (studies used the STAI, DASS or a visual analogue scale; a 0 to 10 SUDS rating is a practical substitute [synthesis]).
2. Listen for about 15 to 30 min before the event: 15 min of binaural-beat music before upper GI endoscopy [source: Demirci & Sezer 2024]; 20 min of a 10 Hz beat embedded in natural sound in the emergency department (Weiland et al.) [source: Chaieb et al. 2015]; pre-operative listening in day-case surgery (Padmanabhan et al.: anxiety fell 26.3% with beats vs 11.1% with placebo audio) [source: Chaieb et al. 2015].
3. Where practical, continue through the event: the Shiraz protocol started 3 min before myocardial perfusion imaging and continued until the scan ended (about 15 min) [source: IRCT20140514017684N9].
4. Re-rate afterwards.
Example language (illustrative): "Start the track when you sit down in the waiting room and keep it on until you're called in. Rate your anxiety before and after so we can see if it helps you."
Watch for: working = lower post-rating and the client reports being able to tolerate the event; in the endoscopy trial tolerance and satisfaction improved while the between-group anxiety difference was not significant, so judge by function as well as ratings [source: Demirci & Sezer 2024].

4.4 Post-procedure / recovery listening

Purpose / when: pain and anxiety in early recovery (e.g. after surgery under spinal anaesthesia). [source: NCT07437469]
Steps: a single 30-min session of a 10 Hz (alpha) beat on soft sine carriers (e.g. 400 Hz left, 410 Hz right), started soon after arrival in recovery, via over-ear headphones at a comfortable, adjustable volume, stoppable at any time; the comparator arm is 30 min of self-selected music on the same headphones. Outcomes are pain and anxiety right after surgery and 4 hours later. [source: NCT07437469; trial still enrolling, results unknown]
Example language (illustrative): "When you're back on the ward and feel up to it, you can play this for half an hour, or your own music if you prefer."
Watch for: delirium is an exclusion; stop if confusion appears. For psychotherapists this is mainly relevant to clients preparing for surgery (health-psychology settings) [synthesis].

4.5 Daily home programme for ongoing anxiety

Purpose / when: mild anxiety disorders or chronic tension, as homework between sessions. [source: Chaieb et al. 2015]
Steps:
1. Agree a daily slot, e.g. 30 min per day (Le Scouarnec et al.: one month of delta/theta recordings reduced self-rated anxiety in mild anxiety disorders, and participants chose to listen more often over time; another study used 30 min of delta beats daily for 60 days and reduced trait anxiety) [source: Chaieb et al. 2015].
2. Use slow (delta/theta) beats in the evening, not before driving [source: Chaieb et al. 2015 for band; synthesis for timing].
3. Keep a simple log: date, minutes, anxiety before and after, mood, sleep [synthesis].
4. Review every 1 to 2 weeks (Phase C).
Example language (illustrative): "For the next two weeks, try half an hour each evening and jot down how tense you feel before and after. We'll look at it together."
Watch for: in the 60-day delta study total mood disturbance, tension, confusion and fatigue fell, but the depression and vigour subscales rose; check mood specifically, not just anxiety [source: Chaieb et al. 2015 citing Wahbeh et al.]. Adherence: in the tinnitus study, participants averaging under about 15 min a day or skipping many days were dropped, showing adherence is a real issue [source: Prakash & Konadath 2025].

4.6 Pre-task priming for attention, memory or creativity

Purpose / when: before study, focused work or creative tasks; not a treatment for ADHD (a pilot in children and adolescents found no objective effect, only subjectively less inattention). [source: Chaieb et al. 2015]
Steps: brief listening before the task (creativity studies used 3 min of alpha or gamma beats; divergent but not convergent thinking improved, and only in some participants); or before and during the task, which the meta-analysis found better than during only; beta (16 to 24 Hz) beats were used for vigilance with mixed results. [source: Chaieb et al. 2015; Garcia-Argibay et al. 2019]
Example language (illustrative): "Some people find a few minutes of this before they start helps them settle into work. Treat it as an experiment."
Watch for: theta (7 Hz) reduced immediate verbal recall after a single 30-min session in one study, so avoid slow beats right before learning or exams [source: Chaieb et al. 2015 citing Wahbeh et al.].

4.7 Choosing beat type: binaural vs monaural, pure tone vs music

Purpose / when: when a client can't use headphones, finds pure tones unpleasant, or gets no effect.
Steps: offer (a) binaural beats on headphones; (b) monaural beats, which are physical amplitude-modulated tones that also work over speakers and gave larger cortical responses in the studies reviewed; (c) beats embedded in music or natural sound; (d) beats with pink noise, which some studies used to strengthen the percept. [source: Chaieb et al. 2015; Garcia-Argibay et al. 2019; speaker point is synthesis]
Example language (illustrative): "If the plain tones are irritating, there are versions mixed into music or rain sounds. Pick the one you'd actually listen to."
Watch for: acceptability drives adherence; a track the client dislikes will not be used [synthesis].

4.8 Music-of-choice comparison

Purpose / when: when you want to know if the beats add anything, or the client prefers music.
Steps: alternate weeks or sessions of the binaural track and self-selected music of similar length and volume, rating anxiety before and after each; this mirrors the active-comparator arm in the Miami trial and the music-without-beats arm in the Shiraz trial. [source: NCT07437469; IRCT20140514017684N9; within-client comparison is synthesis]
Example language (illustrative): "Let's test it: one week with the beat track, one week with your own calming music, same time each day, and compare."
Watch for: if music of choice works as well, keep the music; the outcome, not the technology, matters [synthesis].

4.9 In-session adjunct to relaxation or before exposure [synthesis]

Purpose / when: a client whose arousal is too high to start a session's work, or as a short down-regulation step after an exposure or trauma-focused session. No source opened tested binaural beats inside psychotherapy sessions; this is an adaptation of the pre-procedure protocol (4.3).
Steps: 5 to 15 min of an alpha or slow-beat track at the start or end of the session, client seated and eyes open or closed by choice; rate SUDS before and after; then proceed with the planned intervention. Do not use during exposure itself if the goal is to experience and tolerate the anxiety, since it may act as a safety behaviour.
Example language (illustrative): "You're very wound up today. Let's take ten minutes with the headphones to bring the level down, then decide where to start."
Watch for: drowsiness, spacing out or dissociation; if present, stop, orient (feet on the floor, name objects in the room) and do not proceed to trauma work that day.

4.10 Tinnitus self-management programme (refer)

Purpose / when: clients with chronic tinnitus distress. This sits within audiology; tinnitus is an exclusion for other uses (NCT07437469).
Steps (as published): 20 min daily via earphones in a quiet place for three months, delta (4 Hz) or alpha (10 Hz) beats on a 500 Hz base, volume set at the lowest level that masks the tinnitus and then kept fixed; tested only in people with normal hearing and without psychiatric conditions. [source: Prakash & Konadath 2025]
Example language (illustrative): "That's worth taking to your audiologist. If they recommend a sound programme, I can help you stick with it and manage the distress."
Watch for: the psychotherapist's role is supporting distress and adherence; selection of stimulus is for the audiologist [synthesis].

4.11 Monitoring adverse effects and stopping

Purpose / when: at every review.
Documented or reported adverse effects:
- Lower mood: a single 30-min theta session raised a depression subscale; 60 days of delta beats raised the depression subscale despite reducing overall mood disturbance [source: Chaieb et al. 2015 citing Wahbeh et al.].
- Reduced immediate verbal recall after theta [source: Chaieb et al. 2015].
- Headache or pressure (especially after long or loud sessions), dizziness or mild nausea, anxiety, agitation or disorientation in sensitive people, disrupted sleep with alerting frequencies near bedtime; usually short-lived [source: Brain.fm safety post, a commercial vendor; attributed].
- Hearing risk from loud prolonged listening [source: Brain.fm safety post citing WHO/NIOSH; attributed].
- Seizures: described as theoretical, with no published case known to the authors; product disclaimers advise stopping at any unusual physical or mental discomfort [source: Weil 2012; Brain.fm safety post].
- A 2025 meta-analysis in Complementary Therapies in Medicine reportedly tracked nausea, vomiting, dizziness and hearing problems as adverse events [source: Brain.fm safety post; meta-analysis uncertain].
- Many trials do not report adverse events at all (e.g. Prakash & Konadath 2025) [source: Prakash & Konadath 2025].
Steps: ask specifically about each item above; stop, lower the volume or change the beat frequency if mild; stop and seek medical advice if strong or persistent [source: Brain.fm safety post]; stop permanently if mood worsens, dissociation or unusual experiences appear [synthesis].
Example language (illustrative): "Any headaches, dizziness, feeling low, or feeling strange or unreal after listening?"

4.12 Harm-reduction conversation for "digital drug" use [synthesis]

Purpose / when: a client uses tracks sold as simulating drug effects, or combines tracks with substances (users in the Global Drug Survey were more likely to report recent prohibited-drug use) [source: RMIT/Barratt et al. 2022].
Steps: ask what they use, why (relaxation, sleep, mood, getting high, connection with "something bigger"), and whether with substances; treat simulated-high marketing as the vendor's claim; give general education that combining altered-state audio with substances can increase disorientation and impair judgement, never listen while driving, keep volume safe; assess the substance use itself and refer as needed; explore the meaning-seeking respectfully. See also 089 Hemi-Sync for programme-specific claims.
Example language (illustrative): "What are you hoping the tracks will do for you? And are you using them on their own or alongside anything else?"
Watch for: escalating use to avoid feelings, sleep loss, dissociative or psychotic-like experiences, or the tracks being part of a broader substance problem.

5. Handling problems

The sources give little problem-handling guidance beyond exclusions, stopping rules and volume. Everything below is [synthesis] unless tagged.

No effect ("I don't feel anything"). Check the set-up first: stereo headphones on (the beat does not exist without them), carriers below about 1000 Hz, track long enough; the meta-analysis found longer exposure and exposure before the task worked better [source: Chaieb et al. 2015; Garcia-Argibay et al. 2019]. Older listeners detect fast (gamma-range) binaural beats less accurately [source: Chaieb et al. 2015]. Try monaural beats or music-embedded tracks (4.7), or run the music-of-choice comparison (4.8). After 2 to 4 weeks with no benefit, stop and use standard relaxation or other evidence-based methods.
Non-adherence. Shrink the dose of time (10 min), tie it to an existing routine (bedtime, commute as passenger), let the client pick the sound, use a log; adherence was an explicit drop-out criterion in the tinnitus study, so expect it [source: Prakash & Konadath 2025 for the drop-out rule].
Overwhelm, anxiety rising, intrusive memories, dissociation during listening. Stop the track, open eyes, orient to the room, slow exhalations, name five things seen; afterwards review what came up and whether trauma stabilisation is needed before any further use. Clients with severe trauma, dissociative disorders, psychosis or bipolar history should not be given long slow-wave or trance-style tracks.
Low mood after listening. Take seriously given the depression-subscale findings [source: Chaieb et al. 2015 citing Wahbeh et al.]; switch to a faster (alpha or beta) track or stop; screen for depression and, if present, follow standard risk assessment.
Headache, dizziness, nausea, ear discomfort, tinnitus. Lower volume, shorten sessions, stop if persistent and refer to GP or audiologist [source: Brain.fm safety post for headache/dizziness guidance; Miami trial for tinnitus exclusion].
Sleep worse. Check for alerting (beta/gamma) frequencies near bedtime [source: Brain.fm safety post]; move to slow beats or stop.
Seizure-like episode, palpitations, fainting. Stop permanently and arrange medical assessment; epilepsy and arrhythmia were exclusions in the Shiraz trial and named cautions by Weil [source: IRCT20140514017684N9; Weil 2012].
Over-reliance or avoidance. If the client uses tracks to avoid every uncomfortable feeling, or plays them during exposure tasks, frame it as a safety behaviour and plan its gradual removal.
Belief in strong or spiritual claims. A client may believe tracks open chakras, produce out-of-body states or replicate drugs. These are the vendors' and communities' claims; explore their meaning and what the client is seeking without endorsing or ridiculing them, and correct only safety-relevant misbeliefs (e.g. that a track makes taking drugs safe). For Monroe Institute/Gateway claims see 089 Hemi-Sync.
Combination with substances. Use the harm-reduction approach in 4.12; do not recommend tracks to accompany drug use.
Rupture ("you're giving me an app instead of therapy"). Acknowledge it, clarify it is optional and an adjunct, and return the focus to the main treatment plan.
Children and adolescents. Studies included children in dental settings and an ADHD pilot [source: Shukla et al. dental meta-analysis summary; Chaieb et al. 2015], but no paediatric safety guidance was found [uncertain]; involve parents, use short sessions and low volume.
Pregnancy. Not named as a contraindication in any source opened [uncertain]; no specific concern found, but encourage discussing with the obstetric team if the client is worried.

Sources

Sources: