Brainwave entrainment is a method which utilizes frequencies of the brain in order to bring about specific desired thoughts and behavior. In other words, brainwave entrainment is used to induce different brainwave states related to: enhanced focus, relaxation, sleep induction, meditation, etc. With the help of a specific stimulus, aural (audio), photic (visual) or the combination of the two, we naturally induce the brain to respond by synchronizing with the stimulus frequency; this is called the “frequency following response”. The assumption is that the human brain has a tendency to change its dominant Electroencephalography frequency (recording of electrical activity along the scalp) towards the frequency of a dominant external stimulus. This is why we also talk about “brainwave synchronization”.
Gamma was dismissed as 'spare brain noise' until researchers discovered it was highly active when in states of universal love, altruism, and the ‘higher virtues’. Gamma is also above the frequency of neuronal firing, so how it is generated remains a mystery. It is speculated that gamma rhythms modulate perception and consciousness, and that a greater presence of gamma relates to expanded consciousness and spiritual emergence.
You won’t recall ever being in this state, but it’s an incredibly important brainwave for your health. In this state, you will be deeply asleep, but not actively dreaming. Your body needs this state to heal and regenerate. On a daily basis, you’ll need to achieve this state when you sleep at night to make sure your body can heal itself. When you’re feeling really sick or your body and mind are working hard, you’ll want to stay in this state a little longer.
Hi Et, In all the feedback and studies I’ve read and looked into over the years, I’ve seen lots of feedback from people talking about how they don’t like the sound of the tones, or they find them irritating in some way. Unfortunately, there doesn’t seem to be any particular reason why one person likes it and the next doesn’t. It’s a bit like normal music, one person’s sweet symphony is another person pneumatic drill. It’s common for people to find it weird and maybe annoying at first, which is how I felt in the beginning. But usually after a few listens you can start to get used to it and appreciate the sound, and especially the feeling it gives you. Personally, I think it can help if you try to embrace the sound, psychologically speaking beforehand. It can also help to have the sound playing at a very low volume, to begin with, then building it up as you get more used to it.
Just so, when you reach a state of meditation you don’t “keep digging”, so to speak. The hole has been dug. All that digging has done what it was meant to do. Once your technique has gotten you into meditation, STOP DIGGING! You’re there. If you keep digging you will frustrate your ability to remain in meditation for any significant period of time. Only resume your chosen technique if and when you slip out of the meditative state. If you’re human then you WILL slip out of that state again and again. Don’t worry about that. That’s how the process works for all of us mere mortals.
The effects are strongest while you are listening to the tones because your brainwaves are synchronized and tuned into the frequency range you desire at that time.  After you've stopped listening the effects can still linger for a while afterwards.  The timescale will vary from person to person and be affected by what you do after you've stopped listening.
There's no doubt that brainwave entrainment audio is a great technology for anyone who is interested in encouraging altered states of consciousness and it certainly can help people to reach deeper states of relaxation than they might normally have access to. I myself will often listen to brainwave entrainment music in order to enhance my practice of meditation. But let’s keep a balanced perspective, put all the marketing hype to one side for a moment and acknowledge that there is no brainwave entrainment technology in this world that can make you meditate like a Zen monk “at the touch of a button”, despite what some might like you to believe. The mind is NOT a machine. It moves through various states of consciousness in an organic way and at a natural pace. We certainly can guide and accelerate that process with the use of brainwave entrainment audio, but we cannot control it with the same sort of specificity and immediacy as you might control the speed of the car you drive.
While the physiological and psychological processes being uncovered by brain science in the study of brainwaves is sometimes complex and still being investigated, certain basic principles are well-established, easily understood, and helpful for achieving the most effectively use of brainwave entrainment when seeking relaxation, improved sleep, lowering of anxiety, or other goals. This important background information and scientific knowledge presented here includes: 
Gamma waves are the fastest brainwave frequency range. Gamma brain waves are believed to link and process information from all other parts of the brain. A high amount of gamma wave activity in the brain is associated with intelligence, compassion, focus and feelings of happiness. High levels of gamma brain waves have also been linked to improved memory and an increased sensitivity to sensory input. Low amounts of gamma brainwave activity have been linked to learning difficulties, poor memory and impaired mental processing.

... [9] While entrainment by binaural auditory beats in the alpha frequency has also been shown to enhance creativity, cognition, memory, and an improvement in intelligence tests and achievement tests in learning disabled boys. [10][11][12][13] The gamma-band activity has been shown to involve in a variety of functions such as attention, memory, and consciousness. Current literature suggests that entrainment by gamma beats promotes cognitive flexibility, modulates visual attention, and enhances creativity. ...

Any other things help you relieve stress? “Yoga is something I always return to. I find there is something about just reconnecting to my breath and surveying my body that allows me to be very honest about how well I am managing to maintain a sense of peace regardless of the chaos around me. On a daily basis, I find cooking to be a wonderful, sensory-rich, hands-on way to unwind from a busy day.”
... Several studies have looked at the possible effects of binaural beats within the alpha range on cognitive abilities. A significant improvement in cognitive processing, as measured by the Stroop Effect exercise, was found by a BB stimulation of 10.2 Hz frequency (Cruceanu & Rotarescu, 2013).Carter and Russell (1993)exposed 8 to 12 year old boys with learning disabilities to 8-week long 10 and 18 Hz BB stimulation sessions, and they found an improvement in Raven's progressive matrices and in a subtest of auditory sequential memory (Carter & Russell, 1993).McMurray (2006)assessed the effect of 7 and 11 Hz BB on alpha brainwave activity, working memory, and attention in healthy elderly people, who are known for experiencing gradual decrease in physiological alpha activity. The 2 minutes exposure to BB resulted in an altered electrical activity in the brain. ...
There is a lot to like about this technology as a potential treatment for sleep problems. It’s low impact and non-invasive, it doesn’t rely on chemical drugs, it’s inexpensive and for most people likely easy to adopt and maintain. In this way, it’s similar to the other behavioral therapies for sleep that I like so much, including meditation and relaxation techniques, and other mind-body therapies.
A potential and generally desired result of brainwave entrainment is hemispheric synchronization. It refers to a state when the brainwave pattern of the right and left hemispheres become alike. It is said that a person with similar activity in both hemispheres tend to be happier, more optimistic and more emotionally stable and less prone to mental illness. Studies found that increased levels of synchronization are found naturally in people who meditate regularly and people who are very happy with their lives in general.
One faulty expectation as it pertains to brainwave entrainment is that listening to an entrainment track is the same as meditating. If you’ve understood the principles so far as they’ve been laid out you understand why this idea is completely untrue. If the answer is not yet obvious to you, read the material covering these principles again and try to grasp their meaning.
Delta brainwaves have the slowest frequencies, ranging between 0.1 and 4 hertz, and these are the brainwave states associated with deep sleep, trance states, and unconsciousness. Few people can remain awake during delta brainwaves states, although this state is recorded in awake infants between ages of three months and one year and also in babies just before birth. Delta waves are also linked with increased production of HGH, DHEA, and the neuro-transmitter serotonin.
Alpha (12hz – 8hz) – Awake, but deeply relaxed. Simply closing your eyes will produce alpha brainwaves. This category is associated with daydreaming, visualization, imagination, light meditation. Brainwave expert Anna Wise called the alpha range the bridge between beta and theta. (More information can be found in Wise’ book The High-Performance Mind)
No, it isn’t, at least not in the way these people are thinking. Neither would any other entrainment product you could purchase for that matter. Part of the problem is the proliferation of utter nonsense about brainwave entrainment one can read all over the internet. There is one site in particular that comes to mind, and the contents of that site are often copied by other websites. It is a list of Hz frequencies with their corresponding (alleged) physical effects. The list runs on for many pages. I won’t bother with the link because you can Google it and find it for yourself if you feel the need for a good laugh, but here are some examples regarding meditation and brainwave entrainment from this site:
The brain will entrain to the strongest stimulus. If you combine binaural beats with isochronic tones, your brainwaves will entrain to the isochronic tones. If anything, when you combine the two I believe it makes the track less effective because it makes it harder for the brain to decipher between the two and synchronise to a single beat. There are lots of websites with compelling marketing about the benefits of combining the two together in some funky way, but I haven’t seen any research or lots of anecdotal feedback even to suggest it’s effective to combine them.

According to a recent study published in the British journal Heart, slow or meditative music is a proven stress buster, so set your dial to a soothing station during your commute. And, if you're stuck in a traffic jam, sneak in this quick exercise: Grab your steering wheel and clench the muscles in your fingers, arms, shoulders and back. Do this until your muscles begin to tremble (about 45 seconds), then release. You'll produce a wave of relief in your upper neck and arms all the way down to your fingers. Just make sure your foot is on the brake when you let go of the wheel! (FYI: pink noise is the newest tool for reducing stress.)
Joe:             The Journey  soundscape took a lot of work. I wanted to bring in the very best of what I knew about brainwave entrainment and to make the best brainwave entrainment product—with the best entrainment technology—that I possibly could. So, there are all sorts of things going on in Journey  to provide a sound bed to support the experience of expansiveness and also communicate elements of the heart-based work I talked about earlier. (See part I of this interview, A Guide to Transpersonal Meditation.)
You have three Theta options. First, you can begin with the 30 minute Alpha Light Meditation, then do the 30 minute Theta Deep meditation that is in the same folder with the Alpha track. This is the most gentle way to introduce yourself to the Theta meditations, as these two tracks are designed to work with each other. This Theta track must be used after the Alpha track, because it begins with the same frequency where Alpha ends.
A warning: Be sure to listen to these two tracks no more than twice each per day. Any more and your beta-thought centers can have TOO much energy in them, causing you to feel like you are on a stimulant. Some people may only be able to listen to each track once per day without feeling over-stimulated. That's fine, just go with what works for you. Sometimes less is more when it comes to brainwave entrainment. Don't push too hard trying to force-grow your brain cells. :-)
You listen to binaural beats using headphones. In each ear, you receive sound at a slightly different frequency (often accompanied by some relaxing background sounds). If your left ear receives a 300-hertz tone and your right ear receives a 280-hertz tone, your brain will process and absorb a 10-hertz tone. That’s a very low-frequency soundwave—one you can’t actually hear. But you don’t need to hear the sound for your brain to be affected by it.

I have read something different about theta waves and learning languages. A University of Washington study tested students resting brainwave activity before learning French. They found that students with a higher amount beta/gamma and a lower amount of delta/theta activity were better at acquiring a second language. When you are dominant in theta, that is the lowest and most deeply relaxed awakened state you can be in. I think it would be much harder to really concentrate, fully understand and learn new information while in a theta state, so I would personally consider using theta while studying.

It might seem obvious that you’€™d know when you’€™re stressed, but many of us spend so much time in a frazzled state that we’ve forgotten what it feels like when our nervous systems are in balance: €”when we’€™re calm yet still alert and focused. If this is you, you can recognize when you’re stressed by listening to your body. When you’re tired, your eyes feel heavy and you might rest your head on your hand. When you’re happy, you laugh easily. And when you’re stressed, your body lets you know that, too. Get in the habit of paying attention to your body’€™s clues.


This version of Theta Waves music is nice to listen to and the theta wave with binaural feeding of different wave lengths might be correct as the author indicates it, but for me it was disturbing that in the general sound track of a constant gliding sound I expect from Theta Healing CDs some ringing sounds like bells constantly interfered just in moments when the brain and mind would go into the meditation state and synchronize both sides of the brain. As I am a musician myself and use a lot of classical music but never normally use music for meditation, I felt a bit disillusioned from this CD. For the purpose of Theta Healing and deep Theta Meditation, I would not use this music, but prefer the Theta Healing CDs. I was really astonished that so many people say they can meditate deeply with this music. Perhaps my brain is somehow different. I asked myself if the author ever has experienced what a deep meditation with no thoughts and complete stillness is. Music is also able to distract us from true meditation and this kind of music does.


Since it’s humble beginnings, the science of brainwave entrainment has evolved to be one of the most potent and powerful ways to unlock the full potential of the human mind. Our audios have been created by brainwave entrainment engineer, Ashton Aiden, and his years of research, expertise, personal experience, and creativity. We are confident that the audios we offer on this site are of the best quality you will ever find, anywhere.
Science shows that massages reduce stress, but you don’t have to go to the spa—you can give yourself one right now. “Learning how to self-massage your foot, head, neck, or shoulders reduces the stress hormone cortisol, boosts your immune system, and increases the feel-good hormones oxytocin, dopamine, and serotonin,” Dr. Serani says. You can even use a tennis ball or cold water bottle on your feet or neck. In addition, try rubbing pressure points like the webbing between your thumb and index finger, or your inner wrist. Another technique is the EFT tapping technique, literally tapping certain points on your body such as in between your eyes, your temples, and the center of your collarbone. “Tapping brings cleansing energy to the meridian points, as your mind directs the energy to what’s unbalanced in the body,” Whitaker says. “This restores your mind and body’s natural balance, which aids in releasing stress, worry, fears, and disharmony.”
When your thoughts start to spin out of control during a stressful moment, stop and reframe your thinking. “By your choice of perspective, you direct how your body will respond—in fight or flight, or in creative choices and solution-based responses,” says Lauren E. Miller, stress relief and personal excellence expert and the author of 5 Minutes to Stress Relief. If you’re stressed about something you fear happening, such as “I’m not going to get this project done and then my boss will fire me,” think instead of what a great opportunity it is to show your boss you’re a hard worker. “Resist the urge to cast yourself as the main character in dramas that have not even occurred,” Miller says. Also, instead of asking why something is happening, ask what you can do to fix it. “Asking ‘why’ pitches you in an endless loop of questions, whereas asking ‘what’ sets you into problem-solving mode,” says Deborah Serani, PsyD, award-winning author of Living with Depression and a psychology professor at Adelphi University. “Moving forward instead of being lost in the circle of worries and “whys” helps to reduce stress.” Try these simple mindfulness stress relievers.
This version of Theta Waves music is nice to listen to and the theta wave with binaural feeding of different wave lengths might be correct as the author indicates it, but for me it was disturbing that in the general sound track of a constant gliding sound I expect from Theta Healing CDs some ringing sounds like bells constantly interfered just in moments when the brain and mind would go into the meditation state and synchronize both sides of the brain. As I am a musician myself and use a lot of classical music but never normally use music for meditation, I felt a bit disillusioned from this CD. For the purpose of Theta Healing and deep Theta Meditation, I would not use this music, but prefer the Theta Healing CDs. I was really astonished that so many people say they can meditate deeply with this music. Perhaps my brain is somehow different. I asked myself if the author ever has experienced what a deep meditation with no thoughts and complete stillness is. Music is also able to distract us from true meditation and this kind of music does.
Since it’s humble beginnings, the science of brainwave entrainment has evolved to be one of the most potent and powerful ways to unlock the full potential of the human mind. Our audios have been created by brainwave entrainment engineer, Ashton Aiden, and his years of research, expertise, personal experience, and creativity. We are confident that the audios we offer on this site are of the best quality you will ever find, anywhere.

Gaia Meditation Delta programs are specifically designed to: improve sleep and healing process. Effects happen at a very deep subconscious level, ideal for powerful reprogramming. If you’re in lack of sleep because you’re a busy business man or because you have insomnia etc., a few hours of our Delta waves programs will trick your brain into thinking it had all the restorative sleep it needs.


Thanks for your appreciation of what I’m doing. I’ve been asked for help with autism a number of times over the years, so it’s something that I’ve often looked into and tried to find new information about. Unfortunately, I’ve yet to find any specific research relating to it and using the type of brainwave entrainment tones I use. There are a number of opinions and claims out here, but I’ve often found them to be conflicting. While some are recommending higher frequency gamma waves, others are recommending lower frequency alpha and theta waves while meditating.
Ever wish a stress superhero could save you from the tension of traffic jams, chaotic meetings, arguments with your spouse, or a toddler’s tantrums? Well, you can be your own stress-busting superhero. Using your senses, you can tap into the power to reduce the impact of stress as it’s happening and stay in control when the pressure builds. Like any skill, learning how to ease stress in the moment takes time, experimentation, and practice- but the payoff is huge. When you know how to quickly relieve stress, you can stay calm, productive, and focused, €”no matter what life throws at you.
Some people believe that using this stuff can be a replacement for meditation. While sitting passively and listening to something that can give you the same effect frequency-wise as meditation, there is still far more benefit to meditating than just entrainment. Meditation and mindfulness allow you to really understand yourself on a level far deeper than technology will bring you.
SPEAKER: You know those people who always seem to be smiling? What's their secret? Turns out a lot of the smiles come from saying sayonara stress. Want in on that action? Well, here are three ways to stress less so you can smile more. First up, play your stress away/ why should kids have all the fun? Your boss might not let everyone out for recess, but you can find 15 minutes every day to do something you really enjoy. Go to a driving range. Play ping pong, cards, or board games. Just keep it friendly. Remember, winning isn't everything. Number 2. Give it up for pet power. Have you ever seen anyone looking stressed when playing with an adorable puppy? Neither have we. Interacting with animals has been proven to lower stress in almost everyone. Simply petting a dog or a cat lowers your blood pressure considerably and reduces levels of the stress-causing hormone cortisol. So pet your pooch. Don't have a pet? Borrow a friend's, or visit a local shelter for some much-needed cuddle time. And the number-one way to stress less? Laugh it off. How does laughter love thee? Let us count the ways. Laughter fills your body and lungs with oxygen. It makes your brain release Mr. And Mrs. Happy Hormones, the endorphins. It bolsters your immune system and helps you, well, be well. It also helps your brain release natural pain relievers, and may even stop painful muscle spasms. It's true. He who laughs best stresses less. So learn to play, adopt a stray, and laugh away. You'll feel great. And it will show.
Delta brain state is related to the unconscious or super-conscious mind. Delta waves are the slowest of all five brainwave frequencies. These brain waves are generated in deep sleep and in very deep meditation. In the sleep cycle, the deepest of sleep states is called “Slow Wave Sleep” (SWS). In this phase, the brain begins producing very slow, large Delta waves. The deeper the sleep, the higher the amount of delta waves. This stage plays a vital role in health and well-being, especially because healing and regeneration processes are stimulated in this state. In the Delta state, you do not dream, you are completely unconscious.

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I have been browsing on the site you linked and have narrowed it down to ‘Deep Meditation Music’ and/or Chakra Healing Meditation’ I feel that could be good for me. There is only one thing that makes me hesitant. The description of the first one says ‘higher spiritual awareness’. I consider myself to be a spiritual person but my energy is to high, I’m to high in my body. I need to connect with the chakra’s in my lower body, instead of (or in addition to) the upper once(s). So ‘higher spiritual awareness’, what does that means? Does that mean the higher chakra’s will be more stimulated/activated?
Dealing with sudden stress—a phone call with bad news, a last-minute assignment from your boss, or an argument with your spouse—triggers a cascade of physical and mental symptoms that can be hard to stop. The first thing to do? Pay attention to your breathing pattern, and make an effort to start taking slow, deep breaths as stress relievers. “Breathing can change how we feel because emotions and breathing are closely connected,” says Emma Seppala, PhD, author of The Happiness Track and a Stanford University psychologist who’s done research on yogic breathing. “A revealing research study showed that different emotional states are associated with distinct respiration patterns.” In a follow-up study, participants actually started to feel the emotions that corresponded to an assigned breathing pattern. “This finding is revolutionary: We can change how we feel using our breath!” Dr. Seppala says. Deep breathing gets more oxygen to your brain and may lower levels of the stress hormone cortisol.

Joseph Kao, creator of Profound Releasing, Profound Renewal, and Sound Asleep, is a hypnotherapist and a solution-focused therapist with a private practice in Cambridge, UK. Joe was the co-developer of an acclaimed course on conversational hypnosis, and he regularly teaches hypnotherapy and psychotherapy to other therapists. He has also been the head scriptwriter for over 800 professional hypnotherapy recordings. Joe was drawn to the world of philosophy, meditation, and brainwave entrainment technology from an early age, and he’s had a daily meditation practice since 1998.

Monaural beats have similarities to binaural beats, but the two separate frequencies are delivered through a pulse pattern and mixed before they reach the listeners ears, resulting in the advantage of being audible without stereo headphones. However, using stereo headphones intensifies the effectiveness of monaural beats and is recommended for the best effect. 
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After you fully understand the above principles, the next source of poor results to consider arises from faulty expectations and misunderstandings about what meditation and brainwave entrainment are, and what the experience of either one of them is like. Meditation and Brainwave entrainment aren’t synonyms but the misunderstandings about them do have some overlapping areas. Some misunderstandings are common to both while some are unique to one or the other.
2. The other thing you cannot afford to do is evaluate whether or not a technique is having an effect based upon having (or not having) any of those superficial, irrelevant, distracting phenomena discussed above, like face flushing, seeing light swirls, having sensations of this, that or the other thing, etc. Those kinds of phenomena will just lead you down the wrong path and steer you away from the true benefits of meditation. If you’ve already fallen into the trap of this sort of conditioning, using something like the Release Technique, the Sedona Method, or even EFT can be helpful in breaking established conditioned associations.
A warning: Be sure to listen to these two tracks no more than twice each per day. Any more and your beta-thought centers can have TOO much energy in them, causing you to feel like you are on a stimulant. Some people may only be able to listen to each track once per day without feeling over-stimulated. That's fine, just go with what works for you. Sometimes less is more when it comes to brainwave entrainment. Don't push too hard trying to force-grow your brain cells. :-)
CBT focuses on challenging and changing your thoughts first and foremost, since the way you perceive an event (not the actual event itself) means everything in terms of how your body reacts. (10) Once you can identify the root thought pattern that is causing harmful behaviors, you can work on changing how you think about events and therefore react to them.
To get a full answer you should really get in touch with the owner of the app, because it does really depend on how their track is constructed and how they intend it to work. I have one 50-minute sleep track which takes you down into delta (http://www.mindamend.com/shop/sleeping-and-dreaming/sleep-induction-isochronic-tones/) and that is designed to just get you to sleep, so you just let play until the end. If you played that track on repeat it might make you jump and wake you up, as the track begins at a higher frequency. I have another 8-hour sleep track which is meant to be played all throughout the night (http://www.mindamend.com/shop/sleeping-and-dreaming/deep-sleep-8-hour-sleep-cycle/). So it does depend on the individual track you are using.
Maya Mendoza is a published author of 3 personal development books. She has run an NLP / EFT Practice for 29 years helping clients transform problems into personal power. Maya is also a accomplished copywriter and well known Digital Marketing & Social Social Media Strategist - Specializing in Google+ for business. She was named "best marketing consultant" in Glasgow, UK in 2013.  
According to Dr. Mark Hyman, eating whole, real foods restores balance and reduces the effects of stress on your body. Replacing harmful substances such as caffeine, alcohol, and refined sugars, with clean proteins, fruits, vegetables, and healthy fats helps regulate your hormone levels, including stress hormones. Food As Medicine Education Director Kathie Swift, MS, RDN, LDN, FAND, EBQ cites the connection between the gut and brain in relieving stress. The gut and brain are constantly sending signals to each other, so by keeping your microbiota (the bacteria in your gut) healthy, your brain feels less stressed.
“Stress and sleepless nights are closely linked,” Buenaver says. “If you’re in pain, tend to worry, or are coping with a difficult situation in your life, you may have more stress hormones than usual circulating in your body. A poor night’s sleep adds even more. And those hormones may never be fully broken down. It’s like running an engine in fifth gear all the time.”
Everyone knows stress can cause you to lose sleep. Unfortunately, lack of sleep is also a key cause of stress. This vicious cycle causes the brain and body to get out of whack and only gets worse with time. Make sure to get the doctor-recommended seven to eight hours of sleep. Turn the TV off earlier, dim the lights, and give yourself time to relax before going to bed. It may be the most effective stress buster on our list.
Isochronic tones work just the same in delta as they do in alpha, theta and beta and they are widely used in the brainwave entrainment community to help people sleep. Like you, I’ve also seen some websites saying they don’t work in delta, but it’s a bit like the game of Chinese Whispers, where someone makes a comment and then after it gets passed around and shared a lot the message gets distorted and appears to be a fact. I don’t know of any scientific reason why they wouldn’t work in delta. I remember some people talking about this on a brainwave entrainment forum many years ago. They were saying they found isochronic tones a bit too abrupt for using to help them sleep and they preferred binaural beats, as they thought they were a more soothing sound. That was just a personal preference shared by a couple of prominent forum members at the time and some people then took that as a fact for everyone. That’s where I think that belief originated from.
Move your focus to the sole of your right foot. Tune in to any sensations you feel in that part of your body and imagine each breath flowing from the sole of your foot. After one or two minutes, move your focus to your right ankle and repeat. Move to your calf, knee, thigh, hip, and then repeat the sequence for your left leg. From there, move up the torso, through the lower back and abdomen, the upper back and chest, and the shoulders. Pay close attention to any area of the body that causes you pain or discomfort.
The objectives and inclusion criteria of the review were clear. Relevant sources were searched for studies, although the restriction to published studies in English meant that the review was prone to publication and language biases. The authors did not state whether steps were taken to minimise the risk of bias and error in the processes of study selection and data extraction (for example, by having more than one reviewer independently make decisions). The authors mentioned which studies were blinded, but it did not appear that study validity was systematically assessed, which made it difficult to judge the reliability of the review findings. The decision to combine studies by narrative synthesis appeared appropriate given the strong clinical heterogeneity between the studies, but the authors failed to quantify the size or statistical significance of the findings reported. The evidence presented appeared to justify the authors’ conclusions that further research was justified, but in view of the dearth of good-quality evidence and problems with methodology and reporting in the review, the conclusions regarding efficacy did not appear reliable.
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