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| Published research articles on the treatment of specific disorders with biofeedback or neurofeedback are available from Cindy Perlin by request. Articles are available on ADHD, seizure disorders, TBI, fibromyalgia, RSD and other disorders. A free DVD, "What is Neurofeedback" is also available. Please email Cindy with your requests at cperlin@nycap.rr.com. The following articles have been written by Cindy and can be found below: MANAGING STRESS FOR BETTER HEALTH MANAGING CHRONIC PAIN BIOFEEDBACK FOR A LIFETIME OF BETTER HEALTH NEUROFEEDBACK TREATMENT OF ADHD MANAGING STRESS FOR BETTER HEALTH Cindy Perlin, LCSW Exercising and eating right are not the only components of a healthy lifestyle. Stress is now thought to contribute to as many as 90% of visits to primary care physicians, and managing stress is an important part of achieving optimum health. Before we can manage stress, we need to have an accurate understanding of what it is. Many people think of stress as the external circumstances in their lives that cause them distress. Technically speaking, this is incorrect. External events are "stressors". "Stress" is a physiological response of the body to a threat to its survival, also known as the "fight or flight response. What happens is that our bodies are rather primitively "wired". Changes in the way our bodies respond have not kept up with changes in the way we live now. Whenever we experience what we interpret as a threat to our survival, our bodies respond as if to an immediate physical threat, such as a tiger chasing us. As a result, our bodies prepare to fight off or flee a physical threat. Changes in our bodies that occur as a result include: increased blood pressure and heart rate; withdrawal of circulation from the hands and feet and concentration of blood flow in the heart, lungs and brain; increased respiration rate; increased blood sugar levels; and increased muscle tension. All these changes are designed to prepare the body for vigorous physical activity. In addition, there is a suppression of bodily functions that are not immediately necessary to preserve our lives at that moment, including digestion, immune system activity and replacement and repair of bodily tissues, so that all of the body's awareness and energy can be focused on surviving the immediate danger. Long Term Effects of Stress These physiological changes can give us extraordinary strength to meet difficult physical challenges. The problem arises, however, when we experience chronic threats to our survival which we can't fight or flee. If we remain in the stress response, the physiological changes become relatively permanent, exhausting us physiologically and emotionally. Chronic stress can lead to high blood pressure, chronic pain due to chronic muscle tension and fatigue, increased susceptibility to infection, asthma, Raynaud's Syndrome, difficulty healing from injury, digestive disorders, difficulty controlling blood sugar levels in diabetics, anxiety, depression, and many other problems. How to reduce stress You can learn to turn off the physiology of stress through instruction in relaxation techniques. Some relaxation techniques work directly with the physiology of stress, such as learning to relax the muscles or breathe more slowly and deeply. Exercise can also reduce the physiology of stress. Since the body is geared up for vigorous physical effort, exercise is a natural way to reduce that tension. Other relaxation techniques work on a cognitive (thought) level, since it is the thought about what is happening that triggers the physiology of stress. Techniques include those that quiet the mind, such as meditation, and techniques that replace negative, worry thoughts or images with positive thoughts and images. Interrupting the stress response at any of these levels will cause the body to go into the opposite response, the relaxation response, with corresponding positive physiological and emotional changes. Learning relaxation techniques is relatively simple. Mastering these techniques for optimum benefit requires commitment and practice, much like an exercise fitness program. Most of us have forgotten how to deeply relax, and we must relearn this skill. It can be helpful to get coaching in these techniques from a trained professional through individual counseling or a group stress management program. Biofeedback, which provides direct, immediate information about physiology during relaxation practice, can be of significant benefit in learning relaxation skills. You can get started on your own by trying the following relaxation technique whenever you are feeling stressed: 1. Take a deep breath and let it out in a sigh. This slows and deepens your breathing. 2. Focus your attention on your breath. 3. On the inhalation, think the word "relax". 4. On the exhalation, think the words "let go". 5. Continue to focus on your breathing, inhale "relax", exhale "let go", and if your mind wanders, bring it back to the breath. 6. This can be done for any length of time. Five minutes can make a significant difference in your stress level. For best results, 20 minutes twice a day is recommended. Note: Do not beat up on yourself when your mind wanders--that is the nature of the mind. You are training your mind in this exercise, so just gently bring your attention back to the breath as soon as you notice your mind has wandered. Do not try to change the breath, which can create tension. Just watch the breath going in and out of your body. This technique can be done with the eyes open or closed, but is easiest when done with the eyes closed. Managing Chronic Pain Cindy Perlin, LCSW Chronic pain can be a devastating problem, rendering its sufferer unable to work, perform routine tasks or enjoy previously pleasurable activities. Relationships with families and friends often are adversely affected. The chronic pain sufferer often goes to a wide variety of medical specialists with little or no alleviation of pain. The chronic pain sufferer often looks normal and other people often think the person is "faking it" to get out of unwanted responsibilities. It is not uncommon for individuals in severe chronic pain to experience suicidal thoughts because so little hope or support is offered and life has become so intolerable. As the survivor of a chronic, disabling back condition, I know this experience first hand. I also know there is hope and help from a wide variety of approaches you will not usually find out about from your doctor. The most important of these approaches is a mind/body approach. The National Institutes of Health (NIH) recently held a technology assessment conference on chronic pain which brought together experts in behavioral medicine, pain medicine, psychiatry, psychology and the neurosciences. This expert panel concluded that drugs and surgery have had limited success in managing chronic pain, and "integrating behavioral and relaxation therapies with conventional medical treatment is imperative for managing these conditions". Among the therapies the panel found effective were relaxation techniques, hypnosis, biofeedback and cognitive therapy. These mind/body techniques go to the source of much of chronic pain: muscle pain related to overuse of muscles and resulting fatigue. When a person is in emotional distress, they unconsciously tense their muscles, even while at rest, so that their muscles are always working and become fatigued. This emotional distress may have preceded the injury, or may be a result of the injury itself and its consequences. Once a muscle has been injured, such as from overuse or an overextension injury such as a sprain or whiplash, it is more prone to pain from emotional distress. Learning to relax and to rest the muscles can alleviate much of the chronic pain. Other reasons for chronic muscle fatigue and its resulting pain are bracing and guarding. Bracing refers to an instinctive reaction to pain where the sufferer responds to the pain by tensing the muscles, thereby increasing pain. Guarding results from the person's attempt to protect the injured area by overcompensating with other muscles, thus creating chronic tension and pain in areas adjacent to the original injury. The pattern of guarding often becomes habitual, creating pain long after the original injury has healed. Specialized techniques with EMG (muscle) biofeedback are extremely useful in identifying muscle overuse patterns and teaching the chronic pain sufferer to use the muscles more functionally. Another common source of pain is reduced circulation to an area of the body, which can result in chronic inflammation or tissue damage. Relaxation, biofeedback and hypnosis can all be used to alter blood flow and promote healing in such situations. Hypnotic techniques can also be used to distract attention from the pain. Cognitive techniques, which involve teaching the individual to become more conscious of thoughts and how they affect mood and physiology and how to think more positively, are very helpful in reducing the level of emotional distress, and as a result improving the level of functioning. Learning, for instance, how not to worry today about how much pain you will have tomorrow can allow you to start tomorrow more rested and relaxed. Other modalities which can complement the use of mind/body techniques work on the physical level to promote relaxation and healing. These include acupuncture, massage, chiropractic, physical therapy and movement therapy. Dietary changes such as eliminating caffeine and alcohol use, obtaining adequate nutrients to support healing and avoiding allergens are also frequently helpful. An exercise program which includes attention to both strength and flexibility is also an important part of a pain management program. BIOFEEDBACK FOR A LIFETIME OF BETTER HEALTH Cindy Perlin, LCSW Are you interested in a drug-free approach to treating your current health problems that can also lead to a lifetime of better health and improved emotional well-being? If your answer is yes, biofeedback may be for you. Biofeedback is a treatment technique in which people are trained to improve their health using signals from their own bodies. Sensitive electronic instruments are used to detect physiological changes with far greater sensitivity and precision than a person can alone. This feedback or information is used by the biofeedback practitioner to teach the individual how to control the physiological reactions that contribute to illness or that result from physical or emotional trauma. Biofeedback has been shown to be helpful in a wide variety of illnesses. According to an evaluation of recent biofeedback research by the Association for Applied Psychophysiology and Biofeedback, biofeedback has been demonstrated to be effective for the treatment of the following conditions: anxiety disorders; asthma; high blood pressure, migraine and tension headaches; insomnia; TMJ pain; neuromuscular disorders such as Bell's Palsy, low back strain and stroke; chronic pain, including rheumatoid arthritis pain; Attention Deficit and Hyperactivity Disorder; Epilepsy and Raynaud's disease. Pilot studies also suggest that biofeedback may be a useful treatment for many other disorders, including: addiction to alcohol; bulimia nervosa; carpal tunnel syndrome; diabetes; immune system regulation of breast cancer patients; Post Traumatic Stress Disorder ; and tinnitus. Biofeedback measures the physiology related to the illness, and provides moment-by- moment information to the individual so that the individual can learn to control physiological responses related to the illness. Many of these responses relate to changes in the body as a result of stress. When a person is in the stress response, muscle tension, blood pressure, heart rate, blood sugar levels, respiration rate and skin moisture increase. Blood flow to the extremities, digestion and immune system activity decrease. By teaching the individual stress management techniques, including relaxation techniques, while providing feedback about physiological responses, the individual can quickly learn how to control his/her physiology.. Biofeedback for chronic pain or paralysis, where muscle atrophy, contraction or spasm is involved, also helps individuals learn how to strengthen, lengthen, and balance muscles. Efficient use of muscles is also taught. For disorders involving neurological deficits, such as Epilepsy or Attention Deficit Hyperactivity Disorder, treatment involves teaching the individual to produce more brainwaves of a specific frequency known as the sensory motor rhythm. Based on the condition being treated, the biofeedback therapist determines the most appropriate biofeedback modality. The most common types of biofeedback are EMG (muscle), skin temperature, GSR (skin moisture), EEG (brainwave) and heart rate. While the patient is connected to the biofeedback instrument, the biofeedback practitioner provides coaching in producing the desired changes, such as relaxation training. For chronic pain or paralysis, treatment may also include postural adjustments or movement techniques. Patients are asked to practice these techniques on a frequent basis between biofeedback sessions. In subsequent sessions, patients learn other techniques, and progress in mastering the desired physiological changes is monitored. Once the desired physiological changes are mastered in a relaxed setting, patients are taught how to achieve the desired physiological states in situations in everyday life. Learning to achieve a relaxed physiology can help you address your current physical problems, while increasing your emotional wellbeing and helping your body to maintain optimal functioning, putting you on a lifelong path to better health. NEUROFEEDBACK TREATMENT OF ADHD Why should I do neurofeedback treatment for ADHD when drugs are available? Earlier this year, the FDA ordered pharmacists to inform people taking attention deficit hyperactivity disorder (ADHD) drugs - or their parents - about serious heart and psychiatric risks associated with the drugs, including Strattera, Focalin, Dexedrine, Desoxyn, Concerta, Ritalin, and Adderal. Patients using these drugs sometimes experience increases in blood pressure and heart rate. Sudden death has been reported with the use of ADHD drugs in patients with pre-existing heart problems or heart defects. ADHD drugs should not be used in children or adolescents with known serious structural cardiac abnormalities, cardiomyopathy, serious heart rhythm abnormalities or other serious cardiac problems. Sudden deaths, stroke and myocardial infarction have been reported in adults taking ADHD drugs at usual doses for ADHD. Although the role of the ADHD drugs in these adult cases is unknown, adults have a greater likelihood than children of having serious structural cardiac abnormalities, cardiomyopathy, serious heart rhythm abnormalities, coronary artery disease or other serious cardiac problems. ADHD drugs can also have serious psychiatric side effects. There have been reports in patients of all ages taking these drugs of new or worsening thought problems such as suicidal thoughts; new or worsening aggressive behavior or hostility; and new or worsening bipolar illness. Some children and adolescents using these drugs experienced new psychotic symptoms such as hearing voices; believing things that are not true; becoming suspicious; and developing new manic symptoms. Furthermore, the long term effects of ADHD drugs on the brain, including the developing brain and the aging brain, are unknown. Many children experience intolerable side effects such as appetite suppression that results in weight loss and difficulty sleeping. Many people are justifiably concerned about medication side effects and prefer a more natural approach to treating medical problems. What can neurofeedback do for children and adults with ADHD? Neurofeedback is a safe, effective, non-pharmacological treatment for Attention Deficit/Hyperactivity Disorder that can have the following effects on symptoms associated with ADHD: • Improved attention, concentration and focus • Improved task completion and organizational skills • Reduced impulsiveness • Improved behavior and learning • Increased self-esteem • Better school or job performance • Higher intelligence test scores • Improved realization of innate potential • Improved scores on Parent-Teacher rating scales • Prevent the need for, reduce or eliminate the use of prescription drugs to treat ADHD What is neurofeedback? Neurofeedback is a type of biofeedback, also known as EEG biofeedback or brain wave biofeedback. Neurofeedback uses sensitive electronic instruments to measure brain wave frequencies and to feed back that information in a way that is meaningful to the child or adult being treated. How does neurofeedback help people with ADHD? Children and adults with ADHD have fewer mid frequency brain waves, known as low beta brain waves, than people who don’t have ADHD. Low beta brain waves are associated with relaxed alertness, focus and concentration. In addition, children and adults with ADHD have more slow brain waves, known as theta brain waves, than people without ADHD. Theta brain waves are associated with an unfocused, daydream-like state of mind. Sometimes, children and adults who are explosive or irritable also have too many high frequency beta brain waves. By getting feedback about what type of brain waves are being produced, the individual can learn how to produce more of the brain waves associated with sitting still, staying calm and concentrating, and such tasks become much easier over time. How effective is the treatment? 85-90% of treated individuals show significant improvements from treatment. What is involved in neurofeedback treatment? Neurofeedback requires an average of 50 training sessions, with a minimum of two sessions per week. During the training time, sensors are placed on the scalp and ears so that brain waves can be measured. Individuals watch a computer screen that gives them feedback, either in the form of a game or a video that stops and starts based on how their brain is doing, allowing their brain to learn how to produce the desired brain waves. When individuals can consistently produce more of the desired brain waves, and show a corresponding change in problem behaviors, treatment is completed. How long do the effects of treatment last? Fifteen year follow-up studies of treated individuals indicate that for most people the results are permanent. Some people might require occasional booster sessions. |