CES CalmBox: A Complete Guide to Cranial Electrical Stimulation

• What is CES, and where did it come from?
• What can it do, and what can it not do?

By Dr. Douglas Cowan, Psy.D., MFT

Disclosure: Dr. Cowan uses the CalmBox CES device, and his company, CalmWaves, LLC, distributes it to interested parties.

Some of the most useful tools in health care are quiet ones. They do not get headlines. They get used by clinicians who see what they do, and slowly a research base grows.

Cranial electrical stimulation, or CES, is one of those. I have used it in my practice for many years, and this is the article I point people to when they ask what it is, how it may work, and who it may help. I will tell you what is known, and what is not.

A short history

Using electricity to treat the body is old. Writers in ancient Rome described using electric fish for pain. Modern CES devices, which pass a very small current through the head, came out of research on “electrosleep” in Europe and the Soviet Union in the twentieth century, and devices have been regulated in the United States since the 1970s. Today CES devices are cleared by the FDA as Class II medical devices for anxiety, insomnia, and depression (5). Check the labeling of any device you consider.

What neuromodulation means

Neuromodulation is changing nerve activity with a targeted signal, such as electrical, magnetic, or chemical input. The goal is not to replace a brain chemical, as most medications do, but to nudge the networks that regulate mood, stress, and sleep. CES is one of the gentlest and most accessible forms. It needs no surgery, and treatment can happen at home.

What is happening in the brain

A CES device delivers a very small alternating current, usually through clips on the earlobes. A computer model of the head found that significant current passes the skull and reaches cortical areas, and, depending on electrode placement, subcortical areas such as the midbrain, thalamus, and hypothalamus (1). Those are regions involved in arousal, sleep, and stress responses.

A model tells us where current may go. It does not tell us exactly how people feel better. Researchers have proposed effects on brain rhythms and the balance of the body’s stress and calming systems, and these are still being tested.

What the research shows

Encouraging. A randomized, double-blind, sham-controlled trial of 115 adults with anxiety disorders found that active CES improved anxiety and comorbid depression more than a sham device (2). A 2023 randomized, double-blind, sham-controlled trial of people with stress and mild depressive symptoms or sleep problems also favored active CES on depression and stress measures (3).

Cautious. A 2018 systematic review of 26 randomized trials in Annals of Internal Medicine concluded that the evidence for CES is limited. It found low-strength evidence of possible modest benefit for anxiety and depression, mixed results for pain, and no strong evidence for insomnia, and it called for better trials (4).

My reading. CES is a reasonable, low-risk option to consider as part of a full plan for people who have not gotten enough from the basics. It is not a proven stand-alone treatment, and I do not describe it that way. You will see larger claims elsewhere, such as counts of thousands of studies or claims that it helps every condition. I have not found published support for those, and I would rather you hear that from me.

For more on anxiety specifically, see CES for anxiety, insomnia, and depression.

Safety

In trials, side effects are usually mild: tingling or irritation at the ear clips, dizziness, or a headache that passes after the session. Do not use CES if you have a pacemaker or other implanted electronic device. Ask your doctor first if you are pregnant, have epilepsy or a seizure disorder, have a heart condition, or take medication that affects the nervous system. Tell your prescriber if you start CES.

Practical use

The CalmBox is the CES device I use, at roughly $300 through CalmWaves. Follow the maker’s instructions. In general:

• Moisten the ear clips as directed so the current conducts well.
• Start at a level you can barely feel or cannot feel.
• Use it on a regular schedule for the first month. Consistency matters.
• Many people prefer morning or midday sessions, and if CES seems to affect your sleep, change the timing and ask your clinician.
• If you are very sensitive, for example after a concussion or recent trauma, start with shorter sessions and ask your clinician first.
• Keep a short weekly note on anxiety and sleep so you can tell whether it is helping.

Start today

1. Take the GAD-7 check-in for a baseline.
2. Talk with your doctor or therapist about whether CES fits.
3. Build the foundation first: sleep schedule, movement, and slow breathing.
4. If you try CES, track your results for four to six weeks.

The brain can be supported, and the best plans use more than one tool, patiently, over time.

Calm is a skill and a state, and both can be built.

This article is for education and is not medical advice. If you are in crisis, call or text 988 in the United States.

References

1. Datta, A., Dmochowski, J. P., Guleyupoglu, B., Bikson, M., & Fregni, F. (2013). Cranial electrotherapy stimulation and transcranial pulsed current stimulation: A computer based high-resolution modeling study. NeuroImage, 65, 280-287. https://doi.org/10.1016/j.neuroimage.2012.09.062
2. Barclay, T. H., & Barclay, R. D. (2014). A clinical trial of cranial electrotherapy stimulation for anxiety and comorbid depression. Journal of Affective Disorders, 164, 171-177. https://doi.org/10.1016/j.jad.2014.04.029
3. Lee, M., Kim, Y., Yoon, I., & Hong, J. K. (2023). Effects of cranial electrotherapy stimulation on improving depressive symptoms in people with stress: A randomized, double-blind controlled study. Journal of Affective Disorders, 340, 835-842. https://doi.org/10.1016/j.jad.2023.08.062
4. Shekelle, P. G., Cook, I. A., Miake-Lye, I. M., Booth, M. S., Beroes, J. M., & Mak, S. (2018). Benefits and harms of cranial electrical stimulation for chronic painful conditions, depression, anxiety, and insomnia. Annals of Internal Medicine, 168(6), 414-421. https://doi.org/10.7326/M17-1970
5. Kirsch, D. L., & Nichols, F. (2013). Cranial electrotherapy stimulation for treatment of anxiety, depression, and insomnia. Psychiatric Clinics of North America, 36(1), 169-176. https://doi.org/10.1016/j.psc.2013.01.006