There was a slight delay on my Tens Machine (not Caremax's fault). Package came with all the essentials except on how step up VNS. Sent an email for help which they responded fairly quickly. The device is simple to use once you know which settings to choose. So far, very happy with my purchase and service from Caremax. *Update* I have been experiencing every night pleasent dreams (from 4 nights ago). Not sure if the Tens has anything to do with it. I have uploaded a small video to show how easy it is to set up the VNS setting :) This is a copy and paste (response from Caremax in case anyone needs it) of the steps: 1. Press Power/M button to select TENS Mode 2. Press CH button to select the channel with ear clips connected. 3. Press B Button to select the 'Adv Programs' flashing on the screen 2. Press P button until you see Program "02" showing on the screen. 4. Press + button to increase the intensity level and start treatment. (you will see the clock is flashing, if you need to change the setting, please press power button again to stop the clock before making any adjustment. ). It is pre-set to 25Hz at 200 microseconds which means you don't have to tinker with the frequency and/or pluse width. Currently I have it at level 3 instensity for 10 mins daily -for now. I don't suffer from depression or anxiety as I'm just using it as a preventable measure (my family has a history of mental illness). However my son has some GI issues and suffers from mild anxiety which is why I purchased this device in the first place. Just to be clear, he is under the guidance of a pracitioner who is aware of my son's issues so if any side effects occur, I can seek her advice. My only criticism is the ear electrodes. They are uncomfortable for my small ears so I ended up purchasing the Homemedics Pro TENS Machine Ear Clip Electrodes for tVNS which work really well with this device. Overall, I highly recommend the Tens machine + VNS for anyone looking to hopefully prevent using antipsychotic drugs.