EBHSG - JUNE 1997 MEETING

TOPIC: "WHAT IS BIOFEEDBACK THERAPY?"

Ellen Place, R.N., and Certified Biofeedback Therapist, was welcomed back as the featured speaker for the June 10th meeting of the East Bay Headache Support Group. The meeting was held in the Ball Auditorium at John Muir Medical Center with 26 people in attendance.

Ellen has worked as a biofeedback therapist for seventeen years, and eight years ago she opened a private practice in San Ramon. She gave us each a hand-out (attached) to describe how a biofeedback therapist approaches headaches. A headache is actually a full-body phenomena. A migraine affects your serotonin levels, blood vessels, upper gastrointestinal tract, and causes prodromal, or premonitory, symptoms, such as sensitivity to lights and sounds, etc.

There are three types of biofeedback Ellen uses in treating a headache patient:

1.) Temperature feedback = balancing the blood vessels

2.) EMG feedback (electromyography) = balancing the muscles

3.) Breathing feedback = autonomic nervous system

Donna Johnson agreed to be Ellen's patient for a demonstration of the instrumentation Ellen uses to provide information, or "feedback," about her patient's physiology. Ellen demon-strated EMG (electromyography) first, which is the measurement of muscles (whether they are contracted or relaxed). The primary muscles involved when one has a headache are the forehead, temporal, neck, and jaw muscles. Many people clench their teeth, both day and night, and don't realize they're doing it.

Ellen said, "When learning biofeedback, there is no real right or wrong--it's just learning."

We can’t relax all our muscles. Muscles need to be contracting and relaxing to stay in shape.

Why do we experience pain? Ellen said, "It's your body's way to telling you to stop and do something different.’

After static contraction, move your muscles. For instance, if you are taking notes and your hand is all cramped up, relax your hand and move the muscles.

Ellen attached electrodes to Donna's cheeks and on one of her fingers, and three thin lines showed up on the computer screen. There was a line to demonstrate the contraction of each of her right and left masseter (lower jaw) muscles, and the third line was a base line, or starting point. Ellen explained that occasionally the right and left lines are not balanced, suggesting that the patient is experiencing more tension on one side of the face than the other.

Ellen told us that hooking kids up to her biofeedback equipment is easy. They intuitively know how to manipulate the lines by relaxing or contracting different muscles. Adults have a harder time with the machine.

She had the audience do a little exercise--touch the masseter muscles (lower jaw) and clench your teeth. Then relax the jaw and think about what else is relaxing besides your jaw. When your jaw is relaxed, it is hard to have tension in your shoulders. Therefore, when you are feeling tense, drop your jaw and it relaxes your other muscles.

Important point stressed by Ellen--"Teeth don't touch, unless you're chewing."

The question was asked, "How does this make your headache better?" Ellen's answer was, "It makes your awareness better of where you're holding tension." She told us that muscle feedback is very good for awareness, but the autonomic nervous system also needs to be relaxed.

Ellen said the high range she has seen when hooking up head pain patients to her EMG equipment is 8-20 microvolts, and that it is ideal to get that range to drop to 1-2 microvolts. Be aware, however, that the signal can be different on different machines.

Breathing is the most important part of biofeedback therapy. Ellen focuses several sessions on teaching the proper breathing technique. Breathing is about balancing the autonomic nervous system. Ellen said that we hold our breath when asked to exercise. The body dumps chemicals to rev you up. Your breathing then becomes rapid and shallow. This is reverse breathing, a learned response. Babies and animals breathe correctly. To breathe correctly, allow the diaphragm to relax, which causes your abdomen to stick out.

Ellen changed the screen to show Donna's breathing. Donna commented, "Ellen did a stress test the first time she saw me. I couldn't let go of the stress even though she asked me to."

Ellen said our society is very stressful. It is so typical to have a respiration rate of 16-18 (which is caused by upper chest breathing). If you practice diaphragmatically-correct breathing, your respiration rate will be 8-10, or 8-12; or if doing focused breathing, 4-6 or 6-8. With a high respiration rate we become oxygen-deprived because red blood cells cannot be released.

Using biofeedback equipment, the blood vessels in the patient's fingertips are measured--so we can see whether they are constricting or dilating. This changes with every beat of your heart. Blood vessels are more constricted than dilated in the pre-headache phase. The equipment noted that when Donna breathes, the blood vessels in her finger dilate a little and constrict a little.

Ellen added two lines to the screen--to monitor finger temperature and heart rate.

She then had the audience try a breathing exercise. Ellen told us to sit back, put your hand on your abdomen, and imagine you are trying to blow up a balloon with a long skinny neck. Slowly fill the balloon (your abdomen will stick out) and then exhale all the air. It was noted that Donna's temperature raised a little when she did proper breathing. Also, your heart rate will gradually get slower with proper breathing. Donna held her breath to see what would come up on the screen. Her heart rate picked up and the temperature in her finger dropped slightly.

One person in the audience told Ellen that she finds it hard to breathe when she has a headache, and she wanted to know if that was normal. Dr. Stein interjected that her airway may be overactive during a headache and taking a beta blocker might help.

Ellen led us in a relaxation exercise. She told us to get comfortable, close our eyes, and she turned on a tape of the Pachelbel Canon in D (very pleasing classical music with the sound of the ocean surf in the background), and turned down the lights in the room. She told us to imagine filling up the balloon in our abdomen and then to empty all of the old air out of the balloon. Ellen said that imagery is very important. "Erase all of your thoughts. Relax and allow gravity to take over."

After the relaxation exercise, Ellen changed screens again, to one where skin conductance is measured. The patient's temperature is always monitored in biofeedback therapy, but skin conductance, the measurement of the perspiration on your skin, is a graduate level of biofeedback. A clammy, wet feeling is part of your stress response. We may not feel it, but it's still there. She mentioned, though, that a few people are non-responders.

Skin conductance is measured on the screen. Changes are very minute and usually you can't notice changes without seeing them on the screen at first. Your thoughts and emotions affect your physiology. The mind and body work together--emotions are particularly valuable in running the autonomic nervous system.

Ellen gave Donna a test, similar to a lie detector test. Donna was told to choose a number from 1 to 10 and just think about it (not to say it out loud). Ellen then asked Donna if it was a particular number and each time Donna was to answer "no." After going through all the numbers, Ellen then guessed the number Donna was thinking about. Ellen correctly guessed the number Donna had chosen because she was watching Donna's skin conductance response (on the computer screen) to each answer. Each time Donna was asked if the number she had chosen was "2" the line on the screen would go up sharply, and she didn't show that response for other numbers.

Important point--"Don't say you're not stressed when you are. Acknowledging it helps to relieve stress."

Ellen was asked about her private practice. She generally does 50- to 60-minute sessions, and the intake session is at least 90 minutes.

Roger Johnson in the audience gave us his definition of biofeedback therapy--"You learn how to de-stress in biofeedback, and then you're out in the world. With practice you can learn to de-stress on your own."

Ellen told us there are three phases of biofeedback:

1.) Awareness phase, where we learn our personal triggers.

2.) EMG or breathing or muscle activity.

3.) Integration, where we come up with ways to use the skills we learned in biofeedback in our daily lives.

Ellen said to use imagery. There is no need to waste energy being stressed, unless you are in a dangerous situation. It is a much easier way to live--life doesn't have to be that complicated.

Peak performance occurs in a very balanced state. Best athletes don't waste energy, they get focused (with training). We all have the capacity to improve anything we practice. We can get better at it--anyone can learn biofeedback skills.

Ellen was asked how many sessions she recommends for new patients. She said that she won't kick you out until you're ready, or unless you want out. She also said that Kaiser allows ten visits for migraine patients.

There are many things you can use at home for biofeedback, such as a mirror, bathroom scale, thermometer. There is a software program available for $100 which will monitor your skin conductance. There are also tapes on breathing and imagery that you can purchase. Ellen said that biofeedback therapists who work with children have games for them to play.

One member of the audience asked Ellen if she could help a migraine. Ellen said, "No, I can't abort a migraine in the middle of it, only calm down the person. Biofeedback therapy lets the patient get balanced so it doesn't happen again."

The notes provided above were taken by an EBHSG volunteer and have not been reviewed by the speaker for accuracy. If you have any questions regarding the notes, please contact the EBHSG.

The intention of the East Bay Headache Support Group is to provide information and resources. It does not provide medical advice, which should be obtained directly from a physician.