Pediatric Biofeedback Stress Management

Pediatric Biofeedback Stress Management

Kiddie Quieting Response (KQR)

A Choice for Children

Elizabeth L. Stroebel, PHD

*Any use of this information must reference the author*

“Late at night when the pain of her arthritic hips keeps her awake, 11 year-old Marjorie calls on an imaginary friend named QR and the ‘Sixteen Body Friends' who can help make the pain go away. Her friend, she explains, is one of a cast of characters who lives inside her; troublesome ones like Fighty Fist and Grouchy Face and helpful ones like Octopus, Bubble Pipe and Magic Breathing Holes. Marjorie understands that these body friends are only symbols, which help her to manage sensations of pain. She also understands more about the impact of stress and tension on health than many adults. “When I am hurting or mad I say to myself, ‘Marjorie, it's time to do a QR…I get rid of the hurt or the pain.”

-----The Hartford Courant: Stress in Children

The Inextricable Link

In understanding the inextricable link between the mind and the body, Professor L. Rees, Past President of the British Medical Society, asks the following questions regarding the etiology of disease and general illness in children.

1) Why has the child become ill?

2) Why has the child become ill in the way in which he has become ill?

3) Why has the child become ill at this time of his life?

Management and Prevention

The Kiddie Quieting Response: A Choice for Children (ages 4-9) is an adaptation of the adult QR: The Quieting Response , a Six-Second physiological self-regulation technique based on well-established scientific and clinical principles of C. Stroebel, Ph.D., MD. With eyes open, these physiological skills include: awareness and self-correction of the cues and clues of physical stress; control of shallow or rapid breathing; reduction of unhealthy sustained tension in smooth and striated muscles; decrease in the constriction of blood flow; release of generalized tension from faulty bracing (dysponesis) in muscles; and increased sensations of warmth in the periphery of the body. All contribute to pain management.

What is there about children, which make the KQR biofeedback an effective conduit in pain management?

  • Children possess the innate capacity to mobilize defenses and coping strategies which can recruit allusive yet vital emotional and physical forces to reverse the adverse effects of distress related to the child's perception of pain and the implications for the ultimate health outcome.
  • The child's mind is a receptacle of thoughts, emotions, feelings and memory, which effect the complex organism, either to enhance homeostatic balance or to contribute to the onset and progression of illness and disease.
  • Children are uniquely human, individual, poetic, and infinitely complex. The variation and pronounced differences in each child are revealed in a crosscurrent of stored information and exchange among the different kinds of organization and communication network within the child's diversified and complex organism.

What is the Biofeedback? Biofeedback is an objective scientific process, which involves a collective investigation into the interplay between emotions, thoughts, feeling and memory and physiological function. Biofeedback is an objective scientific process, which involves a bridging-bases by which behavior may alter immune function, and, the basis through which immunological changes may affect health. Biofeedback may facilitate a conditioning of the immune system for achieving control of neural and visceral processes that are normally outside the range of conscious awareness.

The Biofeedback Six-Step Process involves

1) Monitoring : Biofeedback equipment has multi monitoring capabilities with non-invasive sensors which monitor and record changes in skin temperature (Thermal); muscular reactivity (EMG); heart rate variability; (HRV); sweat gland activity (EDR); and respiratory function.

2 ) Feedback : Simultaneously, the data is fed back in real time in visually friendly graphics and audio tones to the child, who then views his reactivity and is given simplified explanations in age

3) Therapeutic strategies : With this baseline information and with imaginative, fun physiological KQR strategies, the child learns to self-initiate shifts in his psychological perceptions, which implicitly affect physiological reactivity.

4) Operant Conditioning : Through the process of operant conditioning-trial and error-and reinforcement of the active ingredients of the placebo effect, the child is able to lessen or eliminate the sensation of physical and emotional pain.

5) Compliance : In KQR terms compliance means ‘sticking to what you are doing' that heals.

6) Transfer of training : Once learned, the KQR life long skills are transferred into normal daily life without the need for biofeedback equipment.

Treatment Applications

Treatment with disorders/illnesses for medical and psychological conditions

  • Physical illness and somatoform exacerbated by prolonged emotional and physical stress
  • Chronic pain with prolonged strain
  • Non-pharmacological method to control pain related to procedures and post-operative discomfort
  • Life threatening illnesses-palliative care, i.e., oncology
  • Episodic acute conditions
  • Headache types and related pain
  • Gastrointestinal disorders, i.e., recurrent abdominal pain
  • Respiratory conditions
  • Cardiovascular conditions
  • Neurological movement disorders; i.e. movement disorders, tic, Torticollis and Tourette's Syndrome;
  • Sleep irregularities
  • Generalized anxiety, socialization difficulties, bullying, performance anxiety, dependency issues, selected oppositional/defiant behavior, Attention Deficit Disorder and Hyper activity
  • Post Traumatic Disorders, abuse, neglect, and violence; attachment and abandonment; grief and loss

Health Benefits

  • Joint pharmacological and non-pharmacological treatment
  • Child learns a locus of control when facing discomfort from procedures and for subsequent improved pain management skill.
  • Children with significant physical and psychological limitations benefit. Even though the overt signs of their understanding may be deceptive, the therapeutic gain is visible in the biofeedback display.
  • Recruits the active ingredients of the placebo effect for self-healing by lifting the exhaustion of the spirit and can be measured through visible and sensory feedback.

Children and Family Benefits

In shifting the stress response, the child achieves an alert mind and calm body to reduce fears and lessen anxiety related to traumatic situations. KQR helps to improve concentration, memory and performance. Family member learn the KQR too and thus a common language exists for healing. Family member do not feel left out.

Kids Taking Charge: The Voice of the Child

Kids feel betrayed by disease and pain. KQR biofeedback is the child's

advocate and entry into self-healing and self-doing

  • The biofeedback displays are a visible advocate for the child and provide evidence to argue his case when he feels misunderstood and inadequate to explain physical discomfort and emotional distress. Reinforces the child's power to break the struggle to be heard and believed.
  • The child creates “his own story” in a sequential objective imaginary way, as he records his own baselines, makes comparisons, and figures out what he needs to do to make change in his own hospital ‘Grand Rounds'.This visual data lets the child creatively devise “his portrait” and can proudly state, “This is me”. He does this in his own words, and with his own pictorial representation of his subjective state-dreams, fears, worries, goals and representations of those around him.
  • Biofeedback acts as a grounding device to objectify states of unrelatedness, i.e. panic, confusion, fright and hyper-sympathetic activity. The biofeedback process takes an underlying emotion and links it to a different object, which gives the thought, feeling and emotion a visible presence and validation.-like ‘building an emotional Lego' .
  • Redirects the negative and resistant energy by reframing and reinforcing the power of positive healing energy to reduce and eliminate symptoms and change pain perception.
  • Biofeedback therapy is a partnership role in the pain management program by developing powerful self-protective strategies that do not interfere with procedure but lessen the fear and discomfort.
  • The process is directed by the child's mobilization of “will”, which can directly reshape mind states related to feeling, implicit memory, mediation of fear and heal.

Appropriate Age

  • Many children begin biofeedback around age five. More often than not, it is a question of timing and intuition that determines suitability for therapy.
  • Can the child replicate learned skills and transfer them to his active life? What is the level of parental support? Is there contraindication?Medication effects?

Importance in treatment

  • Biofeedback is a very important tactical aid in the general strategy of treatment, in particular for pain management (Rees, 1999)
  • “A change of any degree in the mental-emotional sphere, conscious or unconscious, induces a corresponding change in the physiology. In turn, each time something changes in the body, it has an effect upon the patient's mental-emotional life.” (Adler, C. 1998)
  • The child connects the objective realities of their illness (i.e. procedures, pain, family dynamics and other psychosocial factors) with the wide variety of subjective experiences (i.e. anticipatory anxiety, loss, progress) which together potentially create distress or harmony.
  • The mobilization of symptoms
  • Activates the active ingredients of the “placebo effect”
  • Powerful locus of control

The KQR Gang for Health

Children meet My Friend QR along with sixteen ‘safety body friends' who are metaphor for physiologic function. These life long friends are Finger Houses (regulating breathing); QR and Little Fish (release of facial tension and pressure on TMJ ); Magic Breathing Holes (heaviness and warmth in the bodies periphery); Magic Jaw String (release of tension in facial muscles ); Bubble Pipe (generalized six-second exercise); Fighty Fist, Finger Ballons, Octopus, Muscle Man, and Rigid Robot, Grouchy Face ; (faulty bracing); My Body Bike Cycle (heightened arousal states); My Very Own good Feeling Self (homeostasis) and other healthy characters.

QR teaches children to pause and discriminate body arousal states.

  • They learn that they have the choice and control to interrupt the fight-or-flight responses and ‘shift body gears' before difficult medical procedures and accompanying unpleasant sensations, overtake their bodies and emotional control.
  • They learn that it is all right to have worries and that QR and the “sixteen body friends” can help them deal with these worries. With these ‘body friends', the children learn how to negotiate with the pain sensations to reduce bracing and tensions, which increase discomfort.
  • They develop coping strategies to deal with other negative stressful aspects of their lives, albeit family dynamics, confinement, on-going treatment, etc. The QR experiences, language, and body friends provide a new set of emotional communication skills that children can share as they face the enormity of what they face.

KQR has been featured in

  • Special feature articles in AP and UP releases internationally
  • The Washington Post
  • Time Magazine
  • The New York Times
  • ABC World News
  • Handbook of Psychiatry
  • USA Today
  • People Magazine
  • MacNeil/Lehrer Hour
  • Science 81
  • Chicago Sun
  • Los Angeles Times
  • Boston Globe
  • BBC News
  • Hartford Courant
  • National Geographic
  • Omni
  • National Education Association
  • Walt Disney Educational Film:

Expectations: Story of Stress

Frequently referenced in medical and clinical publications related to stress management in children and adolescents.

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