To SEE or not to SEE makes a diference

… out the clinical psychophysiological paradigm I use, importantly patients´ are explained basics while showing in on- or off time data. As main focus is on psychophysiological expressions of autonomic systems dynamic behaviors (in individuals!!, not in general but is living individuals´ own behaviors) as well as part of the metabolism, this is quite easy. Patients often get very existed.

To SEE (observe and understand) or not to SEE (observe and understand) makes a huge difference according mine and my colleagues experiences. Also, I am very clear with that patients really understand reasonably what they will do and why they are suggested (!) to do it. This is not only for motivation (which usually function almost too well) but also that, as I see them as coworkers, really fell they are part of the process! In other words, they do it not only while asked but also why they understand and will do it.

Also, when education in group is done, as much as possible are data and explanations paralleled. Why? While information then is directed both to rational verbal systems (human brain according to the Triune Brain Theory) as well as the spatial, limbic, mostly not under direct conscious operation.

This is the secret, as not only I see it, which function well at many “levels”, educational, investigation and intervention levels, where patient one work is the most important part. Integrated biofeedback can be done with equipment but also with own body expressions, which are experienced when we all know what to “look for” mostly requiring frequent practice of course.

Below text about biofeedback from 2007 (machine translated from Swedish) which will be updated ..

 

Biofeedback

Summary: Biofeedback basically means feedback of signals from biological systems to psychological systems – when we are passive or perform behavioral medicine strategies, which can also be capacity-evaluated – and we can in real time or afterwards off-line consciously see the effects of (usually) non-conscious (which we can become aware of afterwards) biological processes where we can SEE the results of what we do and learn TO UNDERSTAND what is happening in above all how we can affect our autonomous nervous system which in principle always reacts to all forms of biopsychosocial stress – non-conscious biological systems that we now consciously planned can influence and see the results! With biofeedback, we can learn to consciously plan for how we practice biofeedback and thereby affect non-conscious processes, especially those that refer to the autonomic nervous system but also some other systems/processes! Biofeedback was developed in the 1960s (see e.g. www.aapb.org) but for several reasons (discussed elsewhere), including the absence of medicines is not usually known in traditional care yet. We use a version called Integrated Biofeedback and include an entire toolbox that everyone can learn and individually tailor for self-care or professional biofeedback treatment that is not done in Sweden, partly because no training is yet available in Sweden! Stress Medicine AB can, however, offer professional Integrated Biofeedback

 

What is psychophysiology and biofeedback?
Psychophysiology is the science of the interaction between psychological – thoughts, emotions/experiences and behaviors on the one hand and physiological reactions on the other. It is a field of science that also integrates psychology and traditional medicine into terms of psychophysiological behavioural medicine (see e.g. ipbm.se) which today provides a platform for biopsychosocial medicine, which in turn is a prerequisite for understanding, investigating and preventing/remedying lifestyle-related diseases and problems. Today we know that social processes, our thoughts and behaviors affect us physically and that our body in turn, or bad luck, affects psychosocial processes.

On the left above clinical weekday c: 1994, Bollnäs clinic, and on the right a graph with data from psychophysiological stress profile analysis – with cStress multi (see tab cStress measurement system)

Biofeedback – biological feedback – means that we more or less directly (depending on which systems react) get feedback from bodily reactions. If we have spider phobia and meet a spider, we react at lightning speed. If we implement relaxation strategies, we can measure physiological reactions in e.g. the autonomic nervous system and if the skin temperature in the hand increases, we know that we relieve the stress gas (sympathetic). With the skin temperature, we measure 1/100 Celsius changes, so sensitive that we normally cannot feel such small changes. But if we have difficulty relaxing, it is important to get safe information even if we cannot feel positive changes.  But with training, we feel more and more ourselves and do not need to use the measurement system. For many of us, it’s important to feel that we’re doing the right thing even if we can’t feel it.

With the measurement systems, we can make visible what is happening in our central stress systems and this also applies both to investigations where we can also measure individual capacity to influence the systems as well as to continuously evaluate the effect of treatment/training efforts. By measuring but different sensors that are cupped to an interface and then to a computer, we can follow and train important stress and recovery systems e.g. when we are going to “take care” of negative stress by affecting, above all, the functions of our autonomic nervous system (ANS) as well as parts of cell metabolism.

This can be done in different ways and with different measurement parameters, e.g . use heart rate data in terms of respiratory sinus arrhythmia (RSA, part of heart rate variability) as a source of information to see if we are doing the right thing, or with the skin temperature showing how we affect the stress gas, part of the ANS, or influence energy systems via the exhale carbon dioxide and oxygen saturation in the blood or muscle relaxation by measuring and seeing the effects of muscle relaxation (EMG) or … the list can be made long. The list of diseases and problems that can be affected can also be made long because, for example, biopsychosocial stress and energy functions are involved in most dysfunctions.

What is special about psychophysiology and biofeedback is that the interaction between psychological (cognitive and precognitive, i.e. older parts of the brain’s automatic activities) and physiological processes, including social processes through the brain’s information processing – how we consciously and automatically process socio-cultural processes.

What happens in our psychological systems affects the body and vice versa. This is what happens to the whole idea of us – extremely complex but since it is reality must also try to understand this complex and analyze/investigate and prevent/remedy when things go “wrong” – dysfunctional that in turn affects symptoms/behaviors. By trying to find reasons (research language = independent variables) for symptoms (research language = dependent variables), we have the opportunity to effectively address through (experts’ – as well as patients’) knowledge – i.e. what we today have with still limited knowledge have satisfactory safe knowledge to use at the individual level as well (ideographic).

It becomes so extremely clear via biofeedback that we ourselves can influence ourselves positively and thus can affect how we feel, which for many patients is motivating and promising! That is the goal of the capacity tests that we use – “learning while doing while seeing”.

How do we recommend using biofeedback and why?
After more than 20 years of clinical experience and good results from working with biofeedback, we believe that the “health market” is ripe for embrace of lifestyle-related biopsychosocial medical “toolbox” where biofeedback is a cornerstone. Here, education constitutes our “treatment platform” and individually “tailored” with or without supervision the “treatment” itself. Why would you do that? Well, lifestyle-related diseases can actually only be prevented or addressed with people (personal) for changes to their lifestyle-related behaviors. Through knowledge and motivational individually designed strategies – where biofeedback is central – of the tool prototypes, we can prevent and remedy.

But many of us really know what to do/eat/… and what not to do/eat/… and yet we don’t – hand on heart! But now we can ask our own heart (via RSA – see above) or skin temperature (FT – see above) how we can be sure that we relax – passively and actively. If we can’t, we can learn. Similarly, we can get autoimmune reactions in order, even if this is a little more complex (and are addressed elsewhere in discussions about whether we can affect inflammation).

That’s why we’re setting up training clinics to provide people with the knowledge and tools to address their lifestyle-related and stress-related illnesses themselves – where this is understood – in terms of more complex and serious ones – should be in collaboration with biopsychosocial medical professionals.  Fortunately, several actors have also started working with biofeedback from an integrated biopsychosocial medical perspective when dieting for lifestyle-related diseases

Our work is therefore basically about teaching patients and also those who do not define themselves as patients to use biofeedback – based on a biopsychosocial medical self-care approach.

Clinical biofeedback is still quite unknown in Sweden. At the same time, it is based on a consensus on the function of the autonomic nervous system and how we can identify dysfunctionality as well as normalize with biopsychosocial medically based training

Biofeedback can be used in many applications, where I think the preventive behavioral medicine part should not be underestimated – even as health promotion and prevention activities; to manage/lower biopsychosocial stress, help people sleep better, get rid of tension and aches, access problematic stomachs, etc. We have many examples of how people with short education learn to permanently normalize their blood pressure, through a combination of behavioral strategies where breathing biologically correct, a quarter of a day for eight weeks. NOTE this only applies if blood pressure is mainly biopsychosocially generated. When metabolic processes, it often takes twice or triple the time. Given one understands what one needs to do, sees (biofeedback) the effect of some of the strategies, makes his activities qualitatively and quantitatively satisfying (documented with psychophysiological stress profile analysis (stressography) and also continues with his program when blood pressure is normalized so that it can stabilize and maintain (best) for the rest of your life. The latter is easily forgotten when you see the results but do not realize “wash out” if you do not continue and make your modified behaviors a habit!

Cognitive Behavior Therapy (CBT), “mindfulness” and applied psychophysiology with biofeedback are a very good combination. The common denominator is that you work with behavioral changes to feel better and on the basis of learning pedagogy.

There are also many interesting biofeedback applications where it is about increasing performance and health hand in hand by taking mastery of negative, dysfunctional stress, e.g. in a workplace or for an athlete or musician.

Biofeedback is based on basic learning pedagogy and knowledge about the brain and what controls stress

Biofeedback training is based on the basics of basic learning pedagogy – operatic conditioning and positive reinforcement – as well as knowledge of how the relationships between our brain and body work as well as what individually creates and causes negative stress. Over the years, reptilian brains and mammalian brains have evolved and since we keep them in our brain (whether il it or not), they activate and control the stress reactions. That part of the brain we (our human brain, neocortex) cannot “talk to”, but it has a completely different language (analog, nonverbal) and interprets external and internal signals in one (non-cognitive), unconscious, automatic way. This was effective a number of 100,000 years ago but in today’s modern world. The stress systems react in the same way as they have during the evolution of primates and humans Faster breathing, increased heart activity, blood to the large muscle group and carbon dioxide in the blood decrease – all to be prepared for what may come. This was functional in the caveman but not fully functional today. Surely it’s just eating drugs that keep these systems in check? No, then there will be a lot of other negative effects because the body’s system interacts.

If, on the other hand, we learn to deal with non-functional stress – sometimes we actually need to act quickly and fight or escape – for example, learn to actively and passively relax – even in different performance situations, we can “turn off” the stress premium. By systematically training on this, we will gradually not react with non-functional stress by releating and focusing instead on problem solutions when we are in vulnerable situations. This is the effect of long-term exercise – operatic conditioning! The most effective way we know today is precisely to use biofeedback because “we see what we do and do what we see” – “learning while seeing while doing while”

For many of us, it takes time to learn such new habitual behaviors. Then it is especially important to be able to see even the small advances to be motivated to continue training, which becomes so clear when following the biological signals directly on the screen.

When is biofeedback suitable for use and what does the evidence look like?

Actually, all kinds of stress-related disorders where an underlying cause is an imbalance in the autonomic nervous system and/or that a person hyperventilates as well as all the different consequences it has for the development of many lifestyle-related diseases and problems .

Prolonged biopsychosocial stress can develop into chronic stress stress that is more or less gradually permanently permanentized into a chronic condition. The reasons for this vary, but regardless of why important biological functions and systems are affected. These include imbalances in the nervous system between sympathetic and parasympathy, imbalance in breathing that can affect both metabolism and heart rate variability, and imbalances in the cardiovascular systems. Some people end up in a state where the body works against them rather than “collaborating” and for many it is difficult to break. It is easy at an early stage, but we often do not feel that. But we can often identify this with stressography (psychophysiological stress profile analysis). Many have a strong sympathy and/or hyperventilate without realizing and/or feeling it. In some of us, the bodily symptoms have become the primary cause of feeling unwell – when these were initially perhaps “just” temporary symptoms of something caused by the life situation.

The problems can then manifest themselves in the form of anxiety, depression, general stress, sleep disorders, elevated blood pressure, gastrointestinal problems, headaches and other types of stress/pain. Often it is a combination of several of these symptoms.

The evidence for working with biofeedback for the above type of inconvenience is good. See, for example, “The european Union’s european union.” Evidence-Based Practice in Biofeedback and Neurofeedback” by Yucha et al (2008) available to order at www.aapb.org. There is a summary of the evidence situation per problem area. The highest evidence includes ADHD, anxiety, chronic pain, headache, blood pressure and sleep.

How can you work with biofeedback?

There are several ways to work with applied psychophysiology:
An analysis and evaluation tool. When we make psychophysiological assessments, this occurs in conjunction with psychophysiological stressography (psychophysiological stress profile test) according to a standardized protocol. Then we see, among other things, how a person can affect their so-called heart rate variability, which is an important marker for the relationship health-ill health. We also see how to react to different forms of stress, what the resilience looks like after a stress boost, whether the person has an ability to relax, what the balance of the nervous system looks like and whether there is hyperventilation – which can actually be masked and difficult to detect without psychophysiological measurement technology.

We also use different types of capacity tests to see, for example, whether you can directly lower your blood pressure, which in fact many people can but did not even think they have that capacity. Not entirely wrong to discover it! At the same time, this does not apply to everyone and also to the goal that you should (basically) always “have” normal blood pressure – for the rest of your life! At the same time, it is very motivating when you see that you yourself have capacities that can be built on. In principle, all patients have a capacity that we can find with these tests and that can then be justified to work on!

Biofeedback can also be used as a tool to evaluate certain treatment interventions.

An educational tool. Most people who work professionally with biofeedback agree that a great value lies in pedagogy. It becomes very visible and clear that what you as a person do and that this has a high relevance to how you feel. When you have the ability to influence important biological systems yourself, it feels encouraging – so encouraging that we sometimes have to try to prevent patients from exercising biofeedback too much. Unfortunately, despite warnings, a few patients have even.m had migraine aches.

“The pole falls down,” many say, even when we use biofeedback as a preventive measure. In many cases, it is about transfer of knowledge from us experts to patients. In fact, patients are an important resource in their own rehabilitation because the results depend on their own activities – where biofeedback forms part of the biopsychosocial medical toolbox. But the knowledge itself does not change – as does the shovel that stands in the corner digs itself – but it is the motivated self-activities that produce results.

Biofeedback is thus a reading instrument: By learning to positively influence one’s body, we can balance the body’s behaviors, increase resilience and thus feel better and at the same time perform well. Biofeedback shows whether we’re on the right track or not.

 

Biopsychosocial stress medicine toolbox

Consists of suggestions for methods/strategies that focus on
to practice biologically correct breathing, calm breathing,
learning relaxation strategies
to eat biologically constructively
to exercise regularly
planning, structuring, .. in her/his own life situation
developing constructive social networks

When implementing a “strategy bundle”, which consists, for example, of an (identified individually effective) respiratory behavior, a cognitive strategy and a movement, biofeedback instruments can see the effect of this dice – which each time involves an operant (biological) learning that gradually becomes more efficient and effective. Many small steps lead to great progress. Seeing what you do and that it’s right what you do is gold worth for most people given you understand what the data “says”.

What are the benefits of biofeedback?

For a patient, the great advantage, of course, is that it results relatively quickly and that he or she then feels better – in the form of reduced stress, lower blood pressure, better sleep, reduced tension, etc. Many people appreciate initially gaining an understanding of the likely reasons why they feel the way they do, as well as being able to follow the results of their training.

For a processor, it is a stimulating and educational way to work with cognitive behavioral strategies and that generates objective data. The fact that it also contributes to improved treatment outcomes is of course important. It can also be a cost-effective method for home training.

 

Can patients rent and train at home themselves?

For home training we use a small finger temperature system that we call cStress FT . The client rents or buys cStress FT. He/she installs a program on his PC and brings with him a small USB device with thermometer that measures with very nice resolution – in one hundredth of a degree. It means you can see effects that you can’t feel. But gradually the effects get bigger and you feel the effects of your strategies. Then you no longer need measuring instruments – the body then becomes the “measuring instrument”. When we learn to relax, we get warmer in our hands, for example – we feel that. This is proof that we are really relaxing. We often propose an eight-week exercise program, which is usually based on breathing training and a number of psychophysiological strategies based on respiratory behavior. While exercising, they follow their finger temperature on the screen – and it should increase when a biological relaxation occurs!

Finger temperature is an easy measure to use. It is the sympathetic (part of the autonomic) nervous system that controls blood flow in superficial blood vessels, such as the fingertips. When we get stressed, they pull themselves together and we get colder if the fingers, when we relax, the finger temperature increases and the sympathetic activity decreases.

The ability to relax is extremely important and is a prerequisite for being able to function well and also to be able to sleep well. Although we measure many other systems, such as respiratory sinus arrhythmia, RSA (part of heart rate variability), the changes in finger temperature are a very important indicator of whether we can relax biologically correctly. Even the level is interesting. 28 degrees Celsius or above it is generally considered biologically normal. There are other factors that affect finger temperature, such as certain medical conditions, certain medicines and nicotine use. Some of us are also more sensitive to cold than others, some suffer from white fingers known as Raynaud’s syndrome/disease. More controlled studies are needed, but recent research suggests that biofeedback is effective even in Raynaud’s syndrome.

The systems we ourselves use for psychophysiological stress profile analysis and biofeedback, we have developed the software ourselves (see www.stressmedicin.se and cStress measurement system) in collaboration with hardware manufacturers.

 

How can you learn more about biofeedback and psychophysiology?

In Sweden, clinical psychophysiology and biofeedback are still not well known. But we have been working on this for over 20 years and offer courses – see further e.g. www.stressmedcenter,com and www.ipbm.se

We also arrange training with certification, where the participant learns about important psychophysiological connections, learns how to analyze and interpret results, learns different therapies and of course for an overview of the evidence situation and for what problems biofeedback is suitable for. Read more about on the website.

In the UNITED States, there is an organization AAPB, Association for Applied Psychophysiology where there are books and courses to order, www.aapb.org.

If you know someone you think would benefit from biofeedback, where would that person turn?

For those who want to train on their own, it is possible to order directly via www.stressmedicin.se and a web shop that we will restart. For those who want to get in touch with more in-depth activities, we will start a new concept “training clinics” for patients where also training nurses

Biofeedback can in principle be used in all forms of intervention when one can see the effect on the biological/physiological system one wants to influence – sometimes even indirectly, e.g. high blood pressure and the influence on the autonomic nervous system that is usually (probably always) involved even if renin – angiotensin aldosterone and autoimmune systems are involved.

An overview of will be compiled below – but on www.aapb.org there is a lot of information to download – a couple of links below.

Links

http://www.aapb.org/i4a/pages/index.cfm?pageid=3463
http://www.aapb.org/i4a/pages/index.cfm?pageid=3419