<![CDATA[BIOFEEDBACK IRELAND - Blog]]>Wed, 19 Sep 2018 05:41:05 +0000Weebly<![CDATA[HRV Biofeedback: part 1 (Biofeedback modalities series)]]>Tue, 17 Jul 2018 11:00:54 GMThttp://biofeedback.ie/blog/hrv-biofeedback-part-1-biofeedback-modalities-seriesYour heart rate changes frequently. Sometimes you automatically respond to an external stressor, all the time you automatically respond to your blood pressure. You also automatically respond to your breathing.
 
A lot of people think their heart beats at the same rate all the time….but it doesn’t. We get the impression that it’s unchanging because when we take our pulse we normally take it for a minute and average it, but it’s not that simple.
 
We had spoken in an earlier blog that even the simple act of moving changes pretty much everything in your body including your HR
 
“So here’s how it works: You’re reasonably relaxed, watching some TV, and your heart is beating at 72 beats per minute. Suddenly you hear a bang (it’s probably just the kids but you’d better check). You climb the stairs your pulse quickens slightly as you go (you tell yourself that you really must get more exercise). By the time you’re at the top you may be working at 110 beats per minute. That’s not a problem. That’s exactly what’s supposed to happen. Your heart adjusts to the new demands but so does your blood pressure, digestion, temperature, sweat, breathing etc. You shout at the kids and go back down again. When you get back to the couch you settle back in, probably grunt or sigh as you expel air” and you return everything to an unstressed balance (homeostasis/allostasis).
 
This is the scenario we are all familiar with and any stressor (internal, perceived or external) will result in us adjusting something to deal with it more efficiently.
 
So with heart rate we can easily see
  • Increases and decreases due to an internal stressor
  • Increases and decreases due to a perceived stressor
  • Increases and decreases due to an external stressor
  • Increases and decreases due to blood pressure
  • Increases and decreases due to breathing
 
But here’s the kicker, they are all causing the heart rate to increase and decrease at different times. It’s like listening to an orchestra where all the members are tuning up and playing something different, a cacophony. Here comes the conductor, she says to everyone, follow my lead and play together.
 
Our equivalent of the conductor is your breathing. If we can teach you to breath at your pace (between 4.5 and 7 breaths per minute), you become the conductor and everything starts to play together. Your heart rate starts to swing dramatically at a regular rate.
 
In the next installment I’ll explain a bit more
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<![CDATA[​Some Background on Breathing (Biofeedback Modalities Series)]]>Mon, 24 Oct 2016 18:02:53 GMThttp://biofeedback.ie/blog/some-background-on-breathing-biofeedback-modalities-seriesPicture
When we start biofeedback training we usually begin with breathing. It’s often used as an anchor for many other techniques taught by biofeedback therapists/clinical psychophysiologists.
 
There are 2 big matters that we need to look at first.
  1. Why is almost everyone in this field (and many others) interested in breathing?
  2. I have been to Yoga/meditation/TaiChi/singing lessons/Feldenchrais or something else and learned all about all this diaphragmatic breathing already so why go over it again?
 


To answer the first question: Why breathing? For one really good answer we have to look at a simple diagram of the nervous system.
 
This diagram and others like it are in high school/secondary and basic anatomy and physiology texts all over the world. They help you understand how you’re wired. (The actual length of the wiring or nervous system depends on how you count but I’ve seen figures that range from 45 to 90,000 miles, one way or another it’s huge, try laying 45 miles of electrical wire sometime, never mind 90,000)


  • Every system in your body is either Voluntary or Involuntary (Somatic/Autonomic to use older and less descriptive though more common terms)
    • For example, your heart is Involuntary (autonomic). Your thigh muscles are governed by your Voluntary (somatic) nervous system. Your Liver, Spleen, Intestines, Kidneys, Pancreas etc. are activated by involuntary nerves but your biceps are voluntary.

OK, simple question:
  • What part of my nervous system do I use when I’m breathing?  If you want to deliberately take a breath while you are reading this, you can, so that makes it  part of the Voluntary (somatic) nervous system. But you breath  behind the scenes all the time (we like to see around 12 or lower a minute, when you're not paying attention) which makes it part of the Involuntary (autonomic) nervous system…Confused?
  • It’s both voluntary and involuntary.  And that’s why we like it. A system with one foot in the Voluntary (somatic) camp and another in the Involuntary (autonomic) camp. If we want to influence the involuntary nervous system and all the organs it influences, we do it deliberately by using breathing in a voluntary way. It’s a great go-between.
 
To answer the second question: I’ve learned how to breath already, do I have to do it again?
  • Many people start therapy and they seem to be breathing fantastically well but there are a small number who look great but when we look a little deeper they’re not getting much benefit. They’re breathing using their diaphragm, their shoulders and chest aren’t moving much, they’re moving their tummies (Rectus Abdominus) they're just not seeing a strong physiological change.
 
To see the immediate physiological effects you can look at Carbon Dioxide and how much is in your breath or you can look at your Heart Rate and how much it varies. I’ll cover these modalities in a later post.


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<![CDATA[Progress (Assessment/Evaluation Series)]]>Mon, 25 Jul 2016 10:45:37 GMThttp://biofeedback.ie/blog/progress-assessmentevaluation-seriesPicture
​In a biofeedback session we measure and record a whole plethora of physiological measures every time you train. As a result you can easily see changes in your physiology. That’s what the whole process of biofeedback hinges on.  You have to be able to accurately see (or hear) yourself. The result of this is that you can look at every one of your sessions as an evaluation. Despite this, it’s still a good idea for you and the therapist to formalise a few of them.
 
So let’s formalise three of them:
  1. The initial evaluation (at the beginning of the process)
  2. A progress evaluation (about half way through)
  3. A discharge evaluation (at the end)
As the number of sessions needed will probably be around 12 or 16 the progress evaluation will probably come at around session 6 or 8.
 
In our case we use a “Locus of Control” questionnaire, a conversation, a Psychophysiological Stress Profile (PSP) and an intake form at the beginning of the process.

  • The ‘Locus of Control’ questionnaire allows us and you to see if you feel that incidences in your life are outside your control
  • The conversation is informal but allows you tell us what's the most important thing we need to focus on
  • I have spoken about the PSP and what we look at in a previous blog. (It takes about 20-30 mins)
  • The ‘intake form’ is just an information gathering tool that we use to get basic information like your name, phone number and address etc. We also ask about previous diagnoses, therapies you have tried before, triggers, surgeries, medications and a few other things
 
The first and last evaluations are similar. The first recorded session gives us a baseline to compare against and the last evaluation should show a change. There may also be a difference in the ‘Locus of Control’ assessment. 

The progress evaluation is a lot more informal.  Rather than just completely rely on data from the instruments it's a session designed for you to assess everything and ask loads of questions. It also falls around the time where we move from an educational format to a more proactive one. You'll start directing the approach we  and be more involved because you will understand what's going on



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<![CDATA[Pain Triggers (Issues/Conditions Series)]]>Sun, 29 May 2016 14:06:20 GMThttp://biofeedback.ie/blog/pain-triggers-issuesconditions-series​I had started to write about biofeedback evaluations (I’ll get back to it) but I received a lot of requests to talk some more about triggers and how they work on a daily basis. So here goes:
 
Everyone with a chronic issue has identified stressors (biological, psychological and social) that act as triggers. Previously, in a post about headaches, I wrote about how triggers were cumulative but there’s another aspect to them that deserves to be looked at.

In regards to migraine I wrote“sometimes what will trigger a migraine on one day may not trigger it on another”. That seemed to cause some confusion so I'll explain. Let’s broaden out a bit beyond migraines though. The same idea holds true for anyone with a chronic pain, anxiety, CRPS, headache, depression, arthritis, cardiac conditions etc. This is how it works:
 
You get up on a Sunday, the sun is shining, you’re going for a picnic with your family and you’re in a good mood. You have a shower, go back into the bedroom to put on clothes and stub your toe on the wardrobe. “Oh F#!@” you yell, grab your toe and check your nail. You move on quickly though “Where did I put the corkscrew and I suppose we’ll need a blanket………
 
Alternatively, you get up on Monday, it’s grey and raining. A full week of work ahead and you’ve got to spend the first part of the morning with your boss in a meeting. Mood - not so great. You have a shower, go back into the bedroom and stub your toe on the wardrobe again. “Oh F#!@” you yell, grab your toe, check your nail, just like you did yesterday but you don’t move on this time. Instead you begin talking to yourself “jeez that was stupid, what a way to start my week” or “I can’t believe I did that, that bloody hurts, I probably won’t be able to walk properly for the rest of the day”.
 
It’s all a bit harsh and you’d never say that stuff to a friend (you might slag them off a bit but you’d be sympathetic, I hope). You’re quite happy saying it to yourself though.
 
What’s important to realise is that not only does the pain feel seem to feel worse on Monday; it is, you’ve actually changed the way your body processes the sensation. The chemicals and the pathways that you use to transmit the pain signals have been altered because your mood is different, not to mention the negativity around telling yourself that you’re “stupid”.
 
So in addition to the triggers being cumulative (see the last post) you have a situation where the same trigger at two different times can have a completely different impact because of the mood you’re in.
 
We’ve only talked about a situation where you can easily see the trigger i.e. in this case it’s immediately painful but the same holds true for any trigger whether you are conscious of it or not. Let’s take a food additive that has routinely caused trouble before:
 
 You’re out to dinner with your nearest and dearest and the chef has put ‘that’ additive in your dish but it doesn’t trigger anything (you’re relaxed and the future looks good).  Now the following evening you’re at home cooking after a tough day at work. You accidently include ‘that’ additive but because you’re tired and cranky this time, it acts as a trigger. The sum of it and all the other potential triggers you have encountered that day and …ouch!
 
Or here’s another:
 
You’ve got to give a presentation at work that afternoon. Normally that’s enough to cause you to have a panic attack/anxiety episode (you don’t like public speaking) but you are going out with friends later that evening. Because you are looking forward to going out, you’re feeling a bit more upbeat than usual and the anxiety doesn’t trigger the panic (this time).
 
 
You get the idea, it’s not just the stressor it’s how you perceive the stressor or in this case, the mood you’re in when you perceive the trigger.]]>
<![CDATA[Migraine (Issues/Conditions Series)]]>Mon, 11 Apr 2016 16:58:48 GMThttp://biofeedback.ie/blog/migraine-issues-seriesHeads up right from the beginning:
If you suspect that you experience migraines, organise to have them/you checked out by your physician. In Ireland, if you wish to have an in-depth assessment, set up an appointment with one of the headache clinics in the country. The Migraine Association of Ireland website page has contact information: http://www.migraine.ie/migraine-specialist-clinics/
 
The first thing to realise is that a Migraine headache is not a just a headache, it’s a neurological disorder with headache as a symptom. Sometimes (it’s rare) but people don’t even get headaches, they get might experience nausea or even get an aura without any pain.
 
There’s a term: “Biopsychosocial”. It comes up when managing all sorts of chronic issues (remember chronic doesn’t mean bad, it means long-term or repeating).  The term implies that chronic issues have biological, psychological and social components.  You can use this concept to help identify triggers as well.
 
A trigger is anything that contributes to the onset of a migraine. As I said before, a trigger can be biological, psychological or social. Indeed, triggers are always a combination of all 3  (whether you can see it at the time or not).
 
The important thing to realise is that triggers are also cumulative and sometimes what will trigger a migraine on one day may not trigger it on another.
 
In another post I’ll talk about how potential triggers change on a daily basis. In regard to their cumulative nature let me give you an example: Imagine that you will get a migraine when you reach 100 points (a purely fictional number).
 
You won’t get to the 100 the same way every time but when you do you’ll get a migraine.
  • So you don’t sleep well the night before (40)
  • You’re anxious about that work meeting/presentation later that day (20)
  • You haven’t done any exercise in 3  days (30)
  • You ate something that you had previously identified as a possible trigger (20)
  • You’re depressed and anxious because of that argument you had with “?” (20)
  • The medication you are taking is not suitable to head off or deal with the headache (30)
Total 160 points
 
You've totaled 160 points so the migraine is inevitable and on the way (if not already here)
 
Instead you learn to manage everything a bit more efficiently (It takes weeks but you do it):
You sleep a bit better (30)
You’re a little less anxious about that meeting/presentation (10)
You have started to exercise regularly (-10)
You’ve become convinced that the food you ate was not as big a trigger as you thought (15)
You’ve re-assessed the argument and your mood is slightly better (15)
The medication you’re taking is suitable and helps you head off the headache (-10)
Total      50

You’re only at 50 points so the migraine is not going to happen
 
This is how management using the biopsychosocial model works. Biofeedback in general and Biofeedback Ireland specialises in helping you identify and knit all the different aspects of the biopsychosocial model. If we look at the six components we already listed you can see how this works.

  • So you don’t sleep well the night before.  
Over period of weeks you learn how to quieten down. You can learn to deliberately produce more Delta EEG activity before you sleep. You learn about sleep hygiene (good habits). Over the period  you begin to find that it takes you less time to fall asleep or you can get back to sleep when you wake up/you’re not falling asleep when you shouldn’t/you’re not waking too early etc.

  • You’re anxious about that work meeting/presentation later that day
Using the biofeedback instruments you can see your Heart Rate (HR), Respiration Rate (RR), your skin temperature, muscle tension, EEG activity in your brain, Blood Pressure (B/P) etc. You learn how to reduce the effect of anxiety. You also learn that anxiety isn’t all bad and how to use it so it doesn’t overwhelm you.

  • You haven’t done any exercise in 3 days
You see about how motivation works and that it is inevitable that you falter (in order to learn). You learn how not to judge yourself and give yourself a break. You see the almost immediate effect on your physiology of giving yourself a hard time.

  • You ate something that you had previously identified as a possible trigger
You start a process where you begin to look again at triggers and view them with a scientific eye.

  • You’re depressed and anxious because of that argument you had with “?”
Everybody talks about “letting go”. We use the instruments so you can learn what it means and how to do it. We use some of the same techniques used in Cognitive Behavioural Therapy to help you reassess your relationships.

  • The medication you are taking is not suitable to head off or deal with the headache
Getting your medication right is essential. Remember, functional use of medication is taking it so you can do the things you need to do so you can minimise the need for it. For example, if a person with lower back pain takes a tricyclic antidepressant like amitriptyline so they can exercise properly…that’s functional.

Sometimes the misuse of the medication can be a cause of the headache being worse such as with a medication overuse headache. Getting the balance right is essential.
Most biofeedback therapists/psychophysiologists are psychologists and do not prescribe. Work with your general physician or specialist to get your meds working for you.

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<![CDATA[Peripheral Skin Temperature (Biofeedback modalities series)]]>Tue, 19 Jan 2016 15:52:30 GMThttp://biofeedback.ie/blog/peripheral-skin-temperature-biofeedback-modalities-seriesWe’ve all taken our temperature at some point. You know, you stick the thermometer under your tongue, in your armpit or somewhere it has no business being. Depending on the site you choose you easily see or figure out your core temperature (the temperature inside your body).

Your normal core temperature will probably be about 37C (98.6F) but depending on a few other factors it may vary slightly (such as the time of the day, whether you’re tired, asleep, hungry, or where you measure it). Though, under normal circumstances the variation isn’t great: 36.12 - 37.8C (97.02-100.04F). It has to be that warm in order for the chemical reactions that keep you alive, to take place. To get an idea of how important this is try and wash a greasy plate in cold water. Now, instead, use hot water. It’ll be a lot easier. Grease, egg yolk or gravy etc. dissolve much more efficiently in warm water and the same thing happens in your body. The chemicals you rely on just work a lot better when there’s a little heat around.
 
However, in biofeedback therapy it’s the Peripheral Skin Temperature (PST) that floats our boat. We’re not so interested in your core temperature (unless you are running a fever or have hypothermia for some reason)
 
Here’s what to expect: We attach a thermometer to your finger (in Biofeedback Ireland we use an electronic one attached to a computer, a bit of elastic tape and the ring finger on your left hand). If you’re relaxing your blood vessels will open up (dilate), blood flow will increase and your skin will get warmer.* More importantly, you can see it on the monitor in front of you and you can learn to control it. You’ll find that as you relax, change the way you’re breathing, or what you’re thinking about, you’ll see your skin temperature increase. It’s our job to keep everything else constant (like the temperature in the room). That way you can be sure that it’s something you’re doing.
 
Basically, when you increase or decrease your peripheral temperature you are changing the way blood is flowing in your body. Knowing how do this helps everybody especially people managing chronic conditions.
 
 
*             This is one of the reasons we use a duvet or blankets at night. Assuming you relax when you sleep, your skin gets warmer and you turn into a radiator. Because you’re radiating all that heat into the air you cover yourself with a duvet or blankets to trap it so you don’t get cold.

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<![CDATA[Introduction to Modalities (Biofeedback modalities series)]]>Wed, 16 Dec 2015 17:05:11 GMThttp://biofeedback.ie/blog/introduction-to-modalities-biofeedback-modalities-series  If it can be measured, it can be fed back but as biofeedback therapists

  1. We don’t want to break skin. Most therapists (unless they’re physicians or nurses etc.) won’t be licensed to stick things into you anyway.
  2. We want to keep it quick (You don’t want to be in a situation where it takes forever to link you to the instruments)
  3. We want to keep it painless (Obvious enough, it’s sort of difficult to ask you to focus if I’m hurting you at the same time).
  4. We want whatever we are measuring and the feedback it to be close to instantaneous (For example,  if you were to tighten up your shoulders you have to be able to see or hear it within a couple of milliseconds so you can link what you’ve just done with what you’re seeing/hearing).
 
With these concepts foremost in our minds, we can measure and feedback a host of different bodily functions. At Biofeedback Ireland we routinely measure and feedback:
  • Your brain activity – brain wave activity. Biofeedback therapists may use an EEG (Electroencephalogram).
  • Your skin temperature – vasodilation/vasoconstriction. Biofeedback therapists may use an electronic thermometer
  • Your muscle activity – tension in your muscles. Biofeedback therapists may use SEMG (Surface Electromyogram)
  • Your sweat response – how much you sweat. Biofeedback therapists may use EDA, GSR, BSR, or SCL (Electrodermal Activity, Galvanic Skin Response, Basal Skin Response, Skin Conductance Level [all different terms for largely the same thing]
  • Your respiration – how fast you breathe and how much control you have. Biofeedback therapists may use a simple strain gauge stretched across your abdomen or chest
  • Your heart activity – heart rate (or what most people call your pulse). How well your heart pumps including your blood pressure/blood volume. Biofeedback therapists may use PPG, ECG or EKG (Photoplytesmograph, Electrocardiogram).
 
There are other many other modalities used by therapists who want a closer look or to get finer detail about a process. For example, a respiratory technician or someone interested might use a caponometer to look at the amount of carbon dioxide you may be exhaling when you breathe.
 
Or for finer detail, I worked with a physiotherapist (PT) who routinely connected her patients to 16 SEMGs so she could accurately see how her patients were recruiting various muscles while she was helping them with rehabilitation after they sustained a Spinal Cord Injury (SCI).
 
I will go into more detail describing each modality in later blogs.
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<![CDATA[Stress and Anxiety (Issues/Conditions Series)]]>Mon, 26 Oct 2015 20:34:01 GMThttp://biofeedback.ie/blog/stress-and-anxiety-issuesconditions-series
There’s a lot has been written about stress and anxiety over the years. “Stress” seems to be one of those words that everybody uses and we all feel we’re stressed, that we live a stressful lifestyle (and we're probably right).
 
Here’s a game though, imagine a conversation between you and a student that doesn’t speak your language.
 
Student: I keep hearing the word “Stress”. What does it mean?
You: Oh that’s easy it’s……… (OK, now  take over, keep it concise and make sure the student can understand it.)
 
My guess is that it’s not as easy as you thought. It reminds me of that colloquial phrase that originally came from the Supreme Court in the US, “I don’t what it is but I know it when I see it”.
 
In biofeedback, we have to be a bit more specific and we have to make sure you and the therapist are using the word in the same way.
 
                  Stress is a change in a physiological system above or below homeostasis.
                                       A stressor is something that causes that change.
 
OK, to explain it. The word “Homeostasis” is not one that most people will have encountered since secondary school. It basically means balance.
 
So here’s how it works: You’re reasonably relaxed, watching some TV, and your heart is beating at 72 beats per minute. Suddenly you hear a bang (it’s probably just the kids but you’d better check). You climb the stairs your pulse quickens slightly as you go (you tell yourself that you really must get more exercise). By the time you’re at the top you may be working at 110 beats per minute. That’s not a problem. That’s exactly what’s supposed to happen. Your heart adjusts to the new demands but so does your blood pressure, digestion, temperature, sweat, breathing etc. You shout at the kids and go back down again. When you get back to the couch you settle back in, probably grunt or sigh as you expel air, and everything returns to homeostasis.
 
So what you’ve done is increased your heart rate (above homeostasis) in response to a stressor (movement, the kids, guilt depending on how you look at it). But, and this is the important bit, you quietened down again soon after. You returned to homeostasis.
 
If the stressor was something else though, like an argument or a job interview or a presentation and you don’t switch off, that’s when you start to lose sleep, get headaches, aches. Now you can safely say “I’m stressed!”
 
 

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<![CDATA[Why Assess [Cont'd] (Assessment/Evaluation Series)]]>Mon, 19 Oct 2015 15:42:00 GMThttp://biofeedback.ie/blog/why-assess-contdIf I’m seeing somebody for the first time I need to know how to get a hold of them again but I also need to know a plethora of information that the intake process in any therapy program should gather. Most importantly for biofeedback therapy though, I need to know how a you react to the various types of stressors that have a tendency to present themselves during the day.  I want to see if you let the effects of the stressor diminish quickly and efficiently (most people including myself don't.)

I also want the you to know the difference between a stressor and stress. I would like to know how you react to different types of relaxation exercise as well. I want to accomplish this in the first 3 sessions if possible, but the question is how to get this information quickly and at the beginning of the therapy program.

In addition to the standard assessment this is where a psychophysiological stress profile (PSP) should be created. There are many examples of different types of PSP but it should consist of a number of tasks that introduce a mild stressor and then let the person relax after the stressor has been introduced. The therapist needs to measure all of the modalities that they usually use during a therapy session. 

I have used the same type of PSP for many years, but recently my practice has quietened down and I am reassessing it. I've been reading “The Clinical Handbook of Biofeedback” by Inna Khazan. Her approach to biofeedback is to integrate the mindfulness component as strongly as possible. I have been doing this for many years, but in chapter 4 she addresses the initial evaluation. She has made me think about redesigning my initial assessment and I have been rereading texts that detail the various possibilities and changed things around a bit]]>
<![CDATA[Why Assess? (Assessment/Evaluation Series)]]>Sun, 11 Oct 2015 18:51:06 GMThttp://biofeedback.ie/blog/why-assess"The getting to know you meeting" is what I call the very first session but I use it to make sure you assess me and the therapy process. I want to make sure you 're comfortable and committed to the task. It also allows me to get a feel of your expectations for the therapy.

I also look for some basic information, including any previous diagnosis and your address and phone number. I hook you up (as an example of the procedure) to a simple surface ElectroMyoGram (sEMG) just so you can see your muscle activity increasing and decreasing as you tighten and relax your extensors (muscles in your wrist).  At the end of the session I ask if it all makes sense. If so, you can either schedule an appointment at that point or give me a call. 

If you think you will continue, I give you an intake and evaluation form so when you arrive back for the second session, where I'll conduct the Psychophysiological Stress Profile  (PSP), you can also  give me the completed form.

The point of it all is to start you thinking and noticing yourself. You have probably already noticed your emotions but this may kick-start a process where you become aware of your own thoughts and behaviours.

The form also acts as a checklist. Each question can potentially become a talking point when you bring back the form. I encourage people to have questions for me as well.
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