what a pain - pageplanetsbcna.pageplanet.com/...mindfulness_based_bf.pdf–68 y.o. cf with h/o...
TRANSCRIPT
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Mindfulness-Based Biofeedback:
Urszula Klich, Ph.D.
Shepherd Pain Institute
Atlanta, Georgia 404-352-2020
Adding a mindfulness-based meditation component to biofeedback
treatment in the stress management of severely injured individuals
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Overview
Introduction
– Experience with complex medical problems
– Unique considerations
Biofeedback
Mindfulness Meditation
Mindfulness-Based Biofeedback (MBB)
– Case studies
– Protocol
– Research
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Introduction
My Background
– Experience
– Training
Complex Medical Patients
– Unique Considerations
– Adjunctive referral sources
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Stressors such as Illness
Are not single traumatic events.
They represent a series of new, ongoing
and continuing demands such as:
– The disease’s symptoms
– Course and prognosis
– Treatment and Side effects
– As well as Social, Emotional, physical and
financial consequences
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Importance of Assessment
Basis for diagnosis and treatment
Failure to adequately assess treatment needs
leads to poor outcomes
Prompt diagnosis and treatment reduces the
morbidity associated with unrelieved
symptoms
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Identify Psychophysiological Concerns
Cognitive- Behavioral- patterns of irrational thoughts, attitudes and habits
Mechanical- asymmetry, ergonomics, muscle misuse/disuse, poor fitting clothes
Behavioral- Posture, smoking, caffeine, sleep
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Identify Psychophysiological
Treatment Plan
Identify goals for treatment
Determine limits of scope of practice
Utilize referral sources
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Biofeedback
Definition- The use of monitoring
instruments to provide physiological
feedback re:
1. Responses not ordinarily under voluntary
control and
2. Responses that ordinarily are easily regulated
but for which regulation has broken down
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Biofeedback
Introduced in the clinical setting 1960s
Abundant scientific research supporting its
efficacy in numerous health conditions: 1. Headaches:
2. Neck, shoulder, and back pain and overall myofascial pain
3. Repetitive Strain Injury, Carpal Tunnel
4. High blood pressure
5. Temporal Mandibular Joint Disorder (TMJ)
6. Raynaud’s Syndrome
7. Diabetes
8. Post Traumatic Stress Disorder
9. Sleep Disorders
10. Rheumatoid Arthritis
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Biofeedback: How it works
Nervous System
Sympathetic Nervous System
Parasympathetic nervous system
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Physiological
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Biofeedback
Modalities
Respiration
Thermal
Electro dermal activity
Heart Rate (RSA training)
Electroencephalography (EEG)
Electromyography (EMG)
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Muscular vs. Non-Muscular Evaluation
Upper Trapezius Evaluation (UTE)
– Series of movements Sitting and standing
– Baseline, shrug, abduct, flex
Psychophysiological Stress Profile
– Artificially induced environmental, cognitive and/ or
emotional stress and recovery periods
Scoring- observe absolute values, values during
challenge, recovery & symmetry for UTE
Awareness- observe patient’s awareness
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Biofeedback
Relaxation Techniques
Diaphragmatic Breathing
Progressive Muscle Relaxation
Guided imagery
Autogenic training
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Mindfulness-Based Meditation
Cultivating a different relationship
with one’s experience
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Mindfulness-Based Meditation
Introduced to western practice 70’s
1. Herbert Benson- (1971) Relaxation Response
2. Jon Kabat-Zinn (1979) MBSR
Growing scientific research re:
1. Reduction in negative mood states
2. Increased immune response
3. Activation of left prefrontal cortex
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Mindfulness-Based Meditation
Definition- Paying attention in a particular
way on purpose in the present moment,
nonjudgmentally -Jon Kabat-Zinn
1. Be Aware
2. Do not control- but allow
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Case Study 1
Background
Brief Medical history
– 68 y.o. CF with h/o Chronic facial pain s/p MVA 28yrs ago
– Multiple orthopedic/reconstructive surgeries, 6 week intensive rehab
– Multiple pain clinics: 3wks Des Moines, Rochester clinic,Chicago, Psychiatric management
Social Context
– 39 yo with 5 children, infant with Down’s, husband killed in MVA 1 yr later
– Failed Attempt to return to work
– Takes care of child till age 10, marries husband with frontal lobe injury s/p MVA, abusive –now NH
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Balanced Approach
Awareness Effort
MBB
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One’s Practice
To know how other people behave takes
intelligence, but to know myself takes
wisdom. To manage other people's lives
takes strength, but to manage my own life
takes true power.
--John Heider: The Tao Of Leadership
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Case Study 2
Background
Brief Medical history
– 58 y.o. CF with 2yr hx pubic/suprapubic pain P= 5/10
– Past tx for fibromyalgia & bursitis around hips
– Presently tried on multiple medications, TPI’s, and PT
Social Context
– Pain s/p sexual interaction in the course of an extramarital affair
Psychological
– Denial...cause of pain as chiropractic
– Cognitive Components of Anxiety and fear
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The Combined Approach
mindfulness
awareness biofeedback
change
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Case 3
1st Assessment and respiration training
2nd Review and diaphragmatic breathing practice - Panic and hyperventilation
- Modification of protocol
3rd
Report of decreased pain and anxiety
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Vulnerability to Stress and Health
Problems
Non-
awareness
Behavior &
body habits
Cognitive
distortions
Habits &
Rumination
Increased Stress,
poor reactions &
health problems
Maladaptive
arousal
Biased
Perception &
Problem
solving
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Mindfulness-Based Biofeedback: Prevention of Stress & Health Relapse
Stressor
Behavior and
body habits
Cognitive
distortions
Mindful
Biofeedback Coping
Observe vs
react
Regain
relaxation
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MBB Treatment Format
Session 1 Assessment
Identification of Target Goals
Establishing expectations
Session 2-3 Diaphragmatic breathing training: Respiration
and Heart rate
Sessions 4-6 Biofeedback training according to tx goals
Relaxation Modalities
Musclular evaluation
Mindfulness modalities
Sessions 7-6 Expansion of MBB skills
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Relaxation Response
Not the same as “relaxing”
Immediate effect
Long term effect
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Contraindications
Non-compliance
History or current behavior
External locus of control
Psychiatric Conditions
Severe depression
Psychopathic personalities
Caution with severe PTSD
* Possibility of decompensation with relaxation
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Mindfulness Based Biofeedback Treatment
Relaxation
Greater Control
Insight
Reduced Need
for Control
Mindfulness
Biofeedback
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Mindfulness Based Biofeedback Treatment
Behavioral Modification
Awareness & Skill
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Overall Treatment Goals
Improved Coping Skills
Improved Functional ability
Improved Quality of Life
Increased Self Efficacy
Internal Locus of Control
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Overall Treatment Goals Summary
HELP PATIENTS
HELP PATIENTS,
&
THEMSELVES HELP
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References Baer, R. (2003). Mindfulness Training as a Clinical Intervention: A Conceptual and Empirical
Review. Clinical Psychology Science and Practice, 10 (2). p. 125-143.
Epstein, M. (1998). Going to Pieces Without Falling Apart. New York: Broadway Books.
Kabat-Zinn, J. (1990). Full catastrophe living: Using the wisdom of your body and mind to face
stress, pain and illness. New York: Delacorte.
Lang, A. J., Strauss, J. L., Bomyea, J., Bormann, J. E., Hickman, S. D., Good, R. C., & Essex,
M. (2012). The Theoretical and Empirical Basis for Meditation as an Intervention for
PTSD. Behavior Modification.
Lutz, A., Dunne, J., Davidson, R. (2007). Meditation and the Neuroscience of Consciousness:
an Introduction. Cambridge Handbook of Consciousness. (Eds.), Zelazo, P., Moscovitch,
M. and Thompson, E. p. 499-554. New York: Cambridge University Press.
Schwartz, M. S., & Andrasik, F. (2003). Evaluating research in clinical biofeedback. In F.
Andrasik & M. S. Schwartz (Eds.), Biofeedback A practitioners guide 3rd ed (pp. 867-
880). Guilford Press.
Shellenberger, R., Amar, P., Schneider, C., & Turner, J. (1994). Clinical Efficacy and Cost
Effectiveness of Biofeedback Therapy (2nd edition). Published by the Association of
Applied Psychophysiology and Biofeedback, Wheat Ridge, Colorado.
Shapiro, S.L., Carlson, L.E. et al. (2006). Mechanisms of Mindfulness. Journal of Clinical
Psychology, 62 (3): 373-386.