I Teach Stress Management; What Does Biofeedback Have To Do With Me?
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Laurie van Someren, M. A.
This article appeared in the 10/99 issue of STRESS NEWS,
the quarterly journal of ISMA-UK
Most teaching of stress management gives people tools and training to help them to help themselves. In contrast to the medical model of I am ill, doctor - give me pills! Stress Management training offers concepts from the wide range available, and help in applying them to the particular situations the sufferer finds distressing. This might include advice on cognitive restructuring, to allow the sufferer to reconceptualise the way they are treated by someone else to make it more bearable. Or it might be as simple as a concept about time management.
One group of sufferers who are particularly hard to help is those who feel themselves as powerless Victims, unable either to alter the stressors they work under, or their physical reaction to them. You may flinch with recognition of the type! But it is the work of two to three minutes with a Relaxometer to show them: First that the harmless little box tells them something about what is going on inside them. When the pitch of the tone goes up, they are getting more aroused. Then that if they sit back, relax, and compose themselves a bit, the pitch of the tone DOES go down. They CAN relax! This recognition that they themselves have the capacity to get to a more relaxed state is the starting point for powerful interventions.
Depending on the particular sufferer, you may want to emphasize:
Here is a mind-body link they were not aware of, in them right now, waiting for them to seize and use it. Here is what they need to develop the skill of relaxing. They have the general idea it is a good thing, but they don't know what to do next. What they need, and get from the instrument quickly and persuasively, is the knowledge of how they are doing. Here is the tool to use while they practice rehearsing in their mind the difficult situations they expect to encounter, first in a mild form, then in more and more intense forms. Each time the rising pitch of the tone tells them the imagined stress is getting the better of them, they back off, shift focus away from the stressor and on to the tone, and work on making it go down.
It is in fact fairly difficult to put briefly into words How to Relax and most of us seem to lose the skill in early childhood! But it is easy to learn the skill again. Some of us in ISMA find it comes easily now, but our clients are those for whom it is hard. What they need is the prompt feedback, which is an indispensable part of learning any skill. And if they are relaxed, they cannot be anxious too.
Take a particular example. A sufferer sits (or lies), having already learned what the tone means, thinking about going on holiday in an aeroplane, which has always induced panic before. Just a little thought gives a big rise in the pitch of the tone. But he is not in fact about to take off; he is simply thinking of it. Because the tone has risen, he ceases thinking of flying and works on getting the tone back down; it comes down. Then he gently move his thoughts back to flying, and of course the pitch goes up again, but this time it does not go up quite so much. Each time the sufferer works on lowering the tone. This stage really does benefit from a friendly helper or coach working with the sufferer. For other people the coach is hardly necessary; the sufferer knows they feel better when they are relaxed but they cannot reach the happy state of relaxation. Here their goal is simple - get the pitch of the tone down! As they succeed so they relax. Everyone who uses the Relaxometer finds they CAN relax in a suitable peaceful setting, and then they can start to learn the skill, and then go on either just getting more and more relaxed, or applying it to particular problems.
One productive use has been with stammers, who stammer at least partly because they are anxious about stammering. Given help in learning to manage their anxiety, they are much better able to handle their condition.
Biofeedback, then, is a tool, an educational aid, for learning valuable skills. In practice many of the psychologists who use Relaxometers do so in a psychotherapeutic way, but that is because of the clients they see, and is not necessary. The Relaxometer can give very valuable insights to people with no psychological problems at all - just a stress problem.
Biofeedback instruments are all intrinsically very safe, because they depend on the user having the motivation to continue to use the feedback sound to control themselves. Any discomfort removes the incentive to continue. (There is a small group of people with low blood pressure who may feel faint or dizzy if they get too relaxed, but people with stress problems usually have high, rather than low, blood pressure).
The Relaxometer and similar instruments provide biofeedback of just one measure, Galvanic Skin Response, because it is simple, quick and useful. GSR is a key indicator of the Fight or Flight reaction in the autonomic system. Autonomic arousal is easy to recognize when it is extreme - we break out in a sweat. But such a strong sign is rare, and it is the job of GSR instruments to make clear to the user the much smaller changes that do occur all the time, but that we do not usually notice. They can be caused by as simple a thing as a noisy vehicle passing, or the realization we have forgotten to do something. As experienced relaxers we may notice these, but our clients need help in detecting and responding.
Other types of Biofeedback are also widely used - muscle tension feedback where a wrong muscle tension pattern has been learned - tension headache, writer's cramp, the dental problem called TMJ syndrome, and simple stiff necks. This sort of feedback is also used in rehabilitation medicine, where it can enormously increase the function of muscles damaged by injury to the nerves, or to the brain, or to the muscles themselves. Whole books are written about this area alone.
Temperature feedback from the fingertips allows people to learn deeper relaxation and seems especially valuable where circulatory problems occur, as in PMS, Reynaud's Disease, and migraine. Like GSR feedback, this feedback has been used in very effective work to reduce chronic high blood pressure. Feedback of brain electrical activity or EEG is more complex to decipher and use, but is very powerful. It has applications in addiction, Attention Deficit/Hyperactivity Disorder, chronic anxiety, and optimal performance.
While these modes of Biofeedback are complex and often need some training to be useful, the simplest and cheapest form of Biofeedback, of Skin Response, is also easy for everyone to understand and to use, and is the most relevant to helping people with stress problems.