Date post: | 14-Dec-2015 |
Category: |
Documents |
Upload: | kiana-neighbours |
View: | 223 times |
Download: | 0 times |
Ronald Glick, MDMedical Director—Center for
Integrative Medicine at UPMC Shadyside
Biofeedback and Cardiac Coherence
Training
Lazarus and Folkman—External pressure exceeds one’s perceived ability to cope
Associated with both psychological and physiological changes
Impact of Stress
Herbert Benson—A physical state of deep rest that changes the physical and emotional responses to stress
Associated with i Metabolismi HR, BP, RRMuscles relaxChange in brain wave activityChange in immunity
Relaxation Response
MeditationGuided imageryRhythmic breathingHypnosisAutogenic trainingYogaBiofeedbackQiGong
Mind-Body Approaches
A process that enables an individual to learn how to change physiological activity for the purposes of improving health and performance.
Precise instruments measure physiological activity such as brainwaves, heart function, breathing, muscle activity, and skin temperature.
These instruments rapidly and accurately "feed back" information to the user.
The presentation of this information — often in conjunction with changes in thinking, emotions, and behavior — supports desired physiological changes.
Over time, these changes can endure without continued use of an instrument. BCIA, AAPB, ISNR
Biofeedback
Education regarding connections between symptoms & physiology
Skills training in changing biofeedback signals corresponding to specific physiologic processes
Development of awareness of the internal states linked to arousal and relaxation
Development of carry-over in recognizing and modifying internal states without the aid of instrumentation
Development of an overall sense of self-efficacy and empowerment for contributing to one’s health and well-being, regardless of the extent to which the presenting problem has been resolved
Goals of Biofeedback
Fun/Gimmicky—Tends to engage people who might not otherwise be interested
Can help to engage someone who isn’t “psychologically-minded”
Depending on modality, doesn’t require quiet room with closed eyes—may be more acceptable to patients who have concerns with loss of control or those somewhat energetic or restless
Can tie in with other phenomena besides relaxation response
Advantages of Biofeedback
Like the Criminal Justice System, the Autonomic Nervous System is represented by 2 separate yet equally important groups
Extensive connections going both ways between the heart and the brain/brainstem
Autonomic Physiology 101
ExcitatoryChemically mediated by adrenalsAss’d with epinephrine/norepiResult in cortisol releaseAssociated with fight or flight
response
Sympathetic System
Braking or dampening systemVagally mediatedAssociated with relaxation response
Parasympathetic System
What you’re measuring is beyond conscious awareness
It’s tied in with a useful physiologic function/system—eg sympathetic/parasympathetic tone
The measure can be altered via awareness and exercises
Altering the measure results in improvement of some symptom
How do you pick a modality for Bioveedback?
Migraines & TTH AAD/HD AUrinary Incontinence AAnxiety D/O BFS/MPS BHeart Dz/HTN BCOPD/Asthma
Level of Evidence (Glick & Greco)
Uses surface electrodes to read out muscle activity
Especially helpful for headaches and myofascial pain
Also can be used for pelvic pain and urinary incontinence
Exercises can be direct—eg PMR vs indirect eg breathing, imagery, autogenics
Some connection with autonomics
Targets for Biofeedback-EMG
Skin conductance related to autonomics/ stress levels—think sweaty palms
Unlike muscles, no direct imagery so relies on other indirect methods
Targets for Biofeedback-GSR
Simplest—both in terms of technology and to learn—simple forms bio-dot and mood rings
Cool hands are ass’d with stressFor migraines rationale is that HA ass’d
with dilatation of cerebral vessels—may be offset by peripheral dilatation
May also help for Raynaud’sMay tie in with visual and sensory
imagery
Targets for Biofeedback-Thermal
Neurofeedback—uses computer algorithm to form Quantitative EEG and analyzes for predominant frequency
Most commonly used/studied for AD/HDProtocols include:Decrease theta/Increase betaIncrease slow cortical potentials
Also may help for Asperger’s & Anxiety D/O’s
Targets for Biofeedback-EEG
Initially described in perinatology with changes associated with fetal distress
Provides a barometer of autonomic balance
Can be described in terms of frequency components
Sorry but a short lesson in Fourier Analysis follows:
Heart Rate Variability
Mediated by parasympathetic system/vagus
i associated withAnxietyDepressionHeart disease
h associated with relaxation response and cognitive focus
Elicited by mind-body approaches & exercise
High Frequency HRV
Physiologic process—HR h with inspiration & i with expiration
Reflects balance between sympathetic & parasympathetic systems
Considered to be vagally mediated
Respiratory Sinus Arrhythmia
Describes a similar cyclic phenomenon to RSA
Relatively consistent frequency Oscillations in blood pressure—ass’d
with baroreceptor reflexOccurs at around 6 cycles/min
slower with athletes & meditators faster in kids and older adults
Mayer Wave
The increase in amplitude of oscillation of a system exposed to a periodic force whose frequency is equal or very close to the natural un-damped frequency of the system
Occurs when the respiratory frequency (RSA) overlaps with baroreceptor frequency (Mayer’s wave)
Explains why much of yogic breathing is practiced at 6 breaths/min
Resonance
Chaos—random pattern from 1 point to the next
Coherence—predictable pattern; from 1 point to the next you can make a pretty good guess as to where it’s heading
Chaos vs. Coherence
High Arousal
Creativity AngerJoy Agitated DepressionFocus
+ Emotions - Emotions
Contentment DepressionCreativity Passivity
Low Arousal
Emotional Awareness/Mastery
Typically relies on infrared probe (ear or finger), picking up on change in skin color with systole
Programs have an algorithm that defines coherence vs chaos & feeds-back info to help a person shift to a coherent pattern
Cues that are used are paced breathing and imagery
HRV Biofeedback
HeartMath Institute has done extensive research, writing of books and monographs, and training
Has developed very engaging software for kids & adults
Has a PC or Mac based system as well as a handheld unit
Focus on heart-centered imagery and positive emotion
HeartMath Emwave
Focus is on achieving resonance of RSA & Mayer’s wave
As the Mayer’s wave frequency varies from person to person, the ideal respiratory rate varies as well
Can be determined by having the patient breathe at various frequencies & see which elicits the greatest spike in HRV amplitude & in the amplitude on the frequency plot
Typically between 4-6 breaths per minuteHas been used for hypertension, asthma,
anxiety, and depression
Resonant Frequency Biofeedback
Glick RM, Greco CM. Biofeedback and primary care. Primary Care: Clinics in Office Practice. 37(1): 91-103. 2010 March.Childe, D. & Martin, H. : The HeartMath Solution, Harper, San Francisco, 1999.Lehrer PM, Vaschillo E, Vaschillo B. Resonant frequency biofeedback training to increase cardiac variability: rationale and manual for training. Applied Psychophysiology & Biofeedback. 25(3):177-91, 2000 Sep. Andrasik F. Biofeedback in headache: an overview of approaches and evidence. Cleveland Clinic Journal of Medicine. 77 Suppl 3:S72-6, 2010 Jul.
References