Saturday Continued

 

Saturday, April 4, 2020

BOS29 Photobiomodulation as Adjunct Intervention for Neurofeedback
Time: 2pm-3:30pm
CE Credits: 1.5
Track: Hot Topics
Level: Intermediate
Session Focus: 50% Clinical/50% Research
Target Audience: Neurofeedback researchers and practitioners, neuroscientists, neurologists, and anyone interested in improving brain functions.

Neurofeedback (NFB) provides information about the brain’s rhythms and functioning in real time. Based on this, sounds, graphics or vibrations are used as rewards to train it to improve functions presented as changes in EEG rhythms (Demos, 2019). The changes are usually incremental, which could require up to 40 weeks to achieve the desired results, and which is not assured. In a similar way, photobiomodulation (PBM) of the brain can also trains brain rhythms. However, PBM achieves this very rapidly – usually in a single 20-minute session with no negative side effects (Saltmarche et al, 2017). In PBM, near infrared (NIR) light directed to the default mode network (DMN) at selected pulses could produce large brain responses (Chao, 2019). This has been suggested in studies involving dementia and acute cognitive processing. We carried out controlled studies that specifically explored neural response to 40 Hz (Gamma) (Zomorrodi et al, 2019) and 10 Hz (Alpha) directed to the DMN of healthy subjects. In the Gamma EEG study, it was found that the power spectrum and connectivity of alpha, beta and gamma increased significantly. Surprisingly, the opposite was found for the slower delta and theta bands where the power spectrum decreased with no significant change in connectivity. In the meantime, there was a global increase in inhibition which is often desirable (Zomorrodi et al, 2019). In the Alpha study, the brain responded differently – only the alpha band at around 10 Hz showed significant increase in power (Zomorrodi et al, 2020). Changes in connectivity also increased in a similar way, in the alpha. These studies tell us that the brain not only responds to PBM significantly, it does so in frequency-specific ways that are desired in NFB. These evidences suggest that PBM could be a potentially powerful adjunct to NFB practice. It also opens investigations on how PBM’s parameters can be adjusted to address psychiatric conditions and even enhance the performance of normal brains.

Learning Objectives:

·       Improve and accelerate neurofeedback outcomes
·       For practitioners, clients should enjoy better satisfaction
·       Have tools and techniques of transcranial photobiomodulation to improve brain functions
·       Offer new options for neuro-modulation techniques
·       Be able to explain photobiomodulation mechanisms

Speaker(s):

·       Lew Lim, PhD, DNM, MBA, Vielight Inc.: Dr. Lew Lim is widely recognized as a knowledge leader in photobiomodulation (PBM), particularly related to brain functions. He is the Founder and CEO of Vielight Inc., known for its brain PBM technology. His innovation in the field is positively affecting tens of thousands around the world, whether to address a brain condition or enhancing performance. Currently, his team is involved in various clinical studies indicating PBM for Alzheimer's Disease, traumatic brain injury, meditation, mental and sports performance, and others. Dr. Lim is a neuroscientist, doctor of natural medicine, engineer and chartered accountant. He has completed the various education disciplines at University of California, Berkeley, Quantum University, Sheffield University, Duke University and other institutions.

 

BOS30 The Myths and Misconceptions of Heart Rate Variability
Time: 2pm-3:30pm
CE Credits: 1.5
Track: Hot Topics
Level: Intermediate
Session Focus: 50% Clinical/50% Research
Target Audience: Anyone who is interested in gaining a deeper understanding of heart rate variability and hear rate variability biofeedback

Heart rate variability is powerful indicator of the body’s ability to self-regulate. Heart rate variability biofeedback has been empirically shown to be an effective intervention for a variety of psychophysiological disorders, such as anxiety, chronic pain, hypertension, and depression. However, heart rate variability is a complicated concept, oftentimes not understood deeply enough by practitioners. This makes heart rate variability biofeedback difficult to explain to patients and, even more importantly, conduct properly with effective results. The purpose of this symposium is to describe and address the most common misconceptions about heart rate variability and heart rate variability biofeedback, providing participants with deeper understanding of the concept and the biofeedback technique.

Learning Objectives:

·       Define the concept of heart rate variability
·       Describe the most common ways to measure heart rate variability and ways to track progress in heart rate variability biofeedback
·       Explain resonance frequency breathing
·       Differentiate between measurements used at baseline and training phases of heart rate variability biofeedback
·       Explain the difference between clinical and sport use of HRV

Speaker(s):

·       Inna Khazan, PhD, BCB, Harvard Medical School: Inna Khazan, PhD, BCB is a faculty member at Harvard Medical School and a clinical psychologist specializing in health psychology and performance excellence training using biofeedback and mindfulness-based approaches. Dr. Khazan is recognized as a pioneer in the area of mindfulness-based biofeedback. She teaches nationally and internationally, including at institutions such as the US Navy Special Warfare, US Army Special Forces, and the Stuttgart Opera and Ballet Company. Dr. Khazan is a member of the board of directors for the Institute for Meditation and Psychotherapy (IMP), Association for Applied Psychophysiology and Biofeedback (AAPB), and Biofeedback Certification International Alliance (BCIA), where she is currently chair elect. Dr. Khazan is the author of numerous journal articles and 2 books: Clinical Handbook of Biofeedback: A Step-by-Step Guide to Training and Practice with Mindfulness and Biofeedback and Mindfulness in Everyday Life: practical solutions for improving your health and performance.

·       Brad Lichtenstein, ND, BCB, The BreathSPACE  Associate & Clinical Faculty at  Bastyr university: Brad Lichtenstein, ND BCB BCB-HRV. believes in the power of breath to restore health and balance. As a naturopathic physician in private practice and a professor at Bastyr University for over two decades, Dr. Lichtenstein has helped people embody the lives they want to live. His approach integrates naturopathic medicine, mind-body medicine and biofeedback, depth & somatic psychology, Eastern contemplative practices, yoga and movement, bodywork and end-of-life care. He participated in a joint research study between the University of Washington and Bastyr University where he provided over 500 guided meditations to hospice patients. Dr. Lichtenstein received his doctorate of naturopathic medicine from Bastyr University. His articles have appeared in several publications and journals and he speaks nationally on topics ranging from stress-reduction, mindfulness and health, mind-body approaches to healing trauma, and issues surrounding end-of-life.

·       Richard Gevirtz, PhD, BCB, Distinguished Professor of Psychology at the California School of Professional Psychology at Alliant International University: Dr. Richard Gevirtz is a Distinguished Professor of Psychology at the California School of Professional Psychology at Alliant International University in San Diego. He has been in involved in research and clinical work in applied psychophysiology and biofeedback for the last 30 years and was the president of the Association for Applied Psychophysiology and Biofeedback, 2006-2007. His primary research interests are in understanding the physiological and psychological mediators involved in disorders such as chronic muscle pain, fibromyalgia, and gastrointestinal pain. In this vein, he has studied applications of heart rate variability biofeedback for anxiety, pain, gastrointestinal, cardiac rehabilitation and other disorders.  He is the author of many journal articles and chapters on these topics. He also maintains a part time clinical practice treating patients with anxiety and stress related disorders.

 

Break (Refreshments)
Time: 3:30pm-4pm

 

BOS31 Providing Rigorous Evidence that Biofeedback Accomplishes Physiological Change
Time: 4:05 pm -5:05pm
CE Credits: 1
Track: Basic Science
Level: Intermediate
Session Focus: 100% Research
Target Audience: Anyone interested in evidence that biofeedback accomplishes measurable physiological change, in addition to improvements in quality of life.

Biofeedback is frequently used to regulate the autonomic nervous system. Rigorous evidence suggests that autonomic nervous system dysregulation is part of many chronic disease processes, and that reversal via other therapeutic interventions (beta blocking drugs, vagal nerve stimulation, spinal cord stimulation) can have significant and meaningful impact for patients with these diseases. Clinical colleagues, however, are often not as willing to believe that biofeedback might have the same advantages, because it is a therapy without the need for surgery, anesthesia, implanted stimulators, prescription drugs, or other modalities with which they are most familiar. In this presentation, Dr. Moravec will discuss the body of evidence which is currently available to support the effectiveness of biofeedback mediated self-regulation in the treatment of chronic conditions which are prevalent today in the US. In the same way that Dean Ornish gained traction for lifestyle interventions by going into the cardiac catheterization laboratory and showing that his program actually decreased the development of coronary artery plaque, we must assemble a body of evidence for the efficacy of biofeedback which focuses on biological impact. While the quality of life and stress management effects are undeniably important to the individual patient, the physiological effects on disease progression or even prevention will be essential for convincing clinical colleagues that biofeedback should increasingly be part of comprehensive treatment packages and programs and therefore covered by insurance companies and health plans. With the advent of population health and big data approaches to medical care, treatments that are not proven to have value will disappear from the available options. Dr. Moravec's talk will focus on the evidence which is already assembled, and that which must be collected moving forward.

Learning Objectives:

·       Explain the value of demonstrating physiological changes resulting from biofeedback therapy
·       Recognize physiological changes in the autonomic nervous system which accompany chronic diseases
·       Summarize the role of biofeedback in reversing autonomic dysregulation
·       List studies which have demonstrated physiological reversal of disease after biofeedback therapy
·       Discuss future research approaches to establishing the efficacy of biofeedback in treating chronic disease

Speaker(s):

·       Christine S Moravec, PhD, Research Scientist / Cleveland Clinic: Dr. Christine Moravec is a research scientist at the Lerner Research Institute at Cleveland Clinic, in Cleveland, Oho. Her research focuses on cardiovascular physiology and pathology. Dr. Moravec is an expert on the physiology of the autonomic nervous system, and has published widely in this area. She has been funded by NIH and the AHA, and has a longstanding interest in the interaction between self-regulation and physiological change, particularly in patients with chronic disease.  She is a member of AAPB, a past member of the AAPB board, and has presented her work at the meeting several times.

 

BOS32 The Future of Biofeedback: Wearables, Devices, and Apps for Biofeedback and NEUROFEEDBACK
Time: 4:05 pm -5:05pm
CE Credits: 1
Track: Hot Topics
Level: Intermediate
Session Focus: 50% Clinical/50% Research
Target Audience: Clinicians and researchers who are interested in, or curious about, the cutting edge products that are available or will soon be available to enhance the application of Biofeedback and NEUROFEEDBACK.

Biofeedback is on the cusp of a revolution in acceptance, understanding, and use as several trends come together. With the development of new technology, smart phones, tablets, and smart watches, the public is getting used to carrying devices with extreme capability. Now the trend  towards being able to wear these devices and to monitor activity is hitting critical mass. With the explosive development of activity trackers, sleeptrackers, even monitoring rings, as well as flexible screens and electrodes, the public is now becoming aware of physiologic monitoring and its usefulness. There currently are apps for Biofeedback, for monitoring heart rate, heart rate variability, electrodermal response, temperature, and blood pressure. In the past two years we saw the development of many different physiological monitoring devices embedded in wearables of various kinds including smart watches by Apple, Samsung, Fitbit and other major companies. This presentation reviews and demonstrates the current and future devices, apps, and wearables as well as discusses their positive and negative features and how they can be used by the Biofeedback practitioner both in-office and for home practice.

Learning Objectives:

·       Learn about wearables and apps as they apply to Biofeedback
·       Observe their functioning
·       Recognize the positive and negative features of the equipment
·       Learn to apply this equipment in clinical practice

Speaker(s):

·       George von Bozzay, PhD, The Biofeedback Institute: Dr. George Fuller von Bozzay is founder and director of the Biofeedback Inst. of San Francisco, emeritus: clinical instructor in psychiatry and behavioral sciences Stanford University Medical Center, associate clinical professor in the department of biological dysfunction University of California Medical School San Francisco, Faculty City College of San Francisco, Author of Biofeedback, Behavioral Medicine and Stress Management: a clinicians desk reference, Biofeedback: Methods and Procedures in Clinical Practice, and numerous other books and articles.

 

BOS33 What We Can Learn from Reading the MORPHOLOGY of Brainwaves
Time: 4:05 pm -5:05pm
CE Credits: 1
Track: Hot Topics
Level: Advanced
Session Focus: 100% Clinical
Target Audience: Researchers and  practitioners who use neurofeedback as well as students who are learning to use neurofeedback should attend this session. Information in this session will also be useful to manufacturers of neurofeedback equipment.

The purpose of this presentation is to demonstrate how familiarity with actual raw brainwaves can reveal rich information about the brain. Morphology refers to the shape of things and when applied to brainwaves, it is the patterns found in raw brainwaves that yield information. From the morphology we can learn two fundamental things about the functioning of the brain: its history and its current condition. The brain records events from the beginning of life and stores the information in its morphology. Events such as illnesses and traumas create specific patterns in the brainwaves that can last a lifetime. The shape of brainwaves, or their morphology, reveals these patterns and provides critical data which is important to clinical outcomes. The field of neurofeedback is based on the neurology of brainwaves obtained using a variety of recording devices. Historically, clinicians determined the state of the recorded brain by reading the actual waveforms written in ink on paper. Over the years, with the development of more sophisticated recording equipment, there has been increased reliance on computer software to interpret information found in brainwave recordings. While EEG background activity varies from person to person, patterns found in specific clinical conditions are the same in all recordings. This consistency lends itself to understanding how such things as frequency and amplitude of the EEG affect brain function. Further, it reveals events in the history of the brain that are important in understanding the context of the client’s condition. By learning to read patterns found in the morphology, clinicians can gain a greater understanding of the brain’s pathology and are guided to more effective neurofeedback protocols. This presentation is designed to demonstrate the ease with which actual brainwaves can be read and the importance of the information they contain.

Learning Objectives:

·       Recognize the importance of patterns found embedded in the raw brain wave.
·       Identify specific shapes in brain waves indicative of certain clinical conditions.
·       Utilize the morphology of brain waves to produce more effective training protocols for NEUROFEEDBACK.

Speaker(s):

·       Penelope Montgomery, Ph.D. BCIA certified Senior Fellow, New Hope For The Brain: Dr. Penny Montgomery has a Ph.D. in Health and Behavioral Medicine Psychology from the University of North Texas. She has been licensed as a Clinical Psychologist in Texas and Missouri. She is a Senior Fellow and board certified by Board Certification International Alliance (BCIA). Penny began her career in biofeedback in 1968 while teaching at the University of Texas Medical School at San Antonio where she taught for 12 years. She co-authored the first clinical textbook on biofeedback published in 1979 by Williams and Wilkins, entitled Clinical Biofeedback: a Procedural Manual for Behavioral Medicine. A second edition was published in 1981. She co-authored the textbook Whispers From the Brain, a manual for neurofeedback, published in 2007. She has authored or co-authored more than 30 research papers in the field and has lectured in educational institutions and professional organizations internationally.

 

BOS34 Alpha the Brain Barometer -The Role of Alpha in Determining Brain Health: Emergent Models & Markers of Brain Deregulation, Disorganization, Standard and Optimal Function
Time: 4:05 pm -5:05pm
CE Credits: 1
Track: Hot Topics
Level: Intermediate
Session Focus: 50% Clinical/50% Research
Target Audience: Neurotherapists and clinicians interested in training optimal brain function.    Neurotherapists and clinicians interested in addressing brain deregulation due to multiple causes.

Alpha has long been established as a marker for brain efficiency... and inefficiency. 10/20  location, amplitude and comparative ratios are often analyzed and fine tuned or otherwise re-trained in the treatment of depression, PTSD, educational difficulties/ADHD, addiction, and fine tuned for the release of creative process, peak and optimal performance. Clinical research is now showing the emergence of new patterns of Alpha. Morphology often ignored and misinterpreted as artifact may indeed be large amplitude Alpha. Previously, these Alpha patterns were only seen in specific seizure disorders and with excessive marijuana use/abuse. These atypical patterns are now being seen in in concussed patients (Donaldson, 2019) and clients with excessive interactive screen use/addiction (Swingle, M. 2012/3). It is possible that this specific large amplitude Alpha deregulation is not ailment specific but rather a signal of extreme brain deregulation. This presentation will explore the role of Alpha in excellence (optimal functioning & peak performance) through to known deregulation and intervention followed by a series of case studies exploring high Alpha amplitude deregulation, implications for further study, and treatment.

Learning Objectives:

·       Explore the multidimensional aspects of Alpha throughout the brain
·       Learn 'traditional' markers of Alpha in excellence/peak & optimal performance
·       learn 'traditional 'markers of Alpha in brain inefficiency e.g., ADHD, PTSD,
·       Identify Alpha patters associated with disorganization
·       Identify (Alpha) patterns associated with injury

Speaker(s):

·       Mari Swingle, PhD Clin Psych, Dr. of Psychology: Dr. Mari Swingle (PhD & MA Clin Psych, MA Ed), practicing (neuro)therapist, researcher, consultant, and author is a BCIA Senior Fellow BCIA, AAPB BOD, and winner of practice and authorship awards including FABBS Early Career Impact Award for her research on technology, the brain, and behavior. She works with a wide range of neurophysiological ailments including Anxiety, Depression, Trauma, OCD and Addiction and is well known for her work with children and families experiencing behavioral and learning difficulties (e.g., Defiance and Conduct Disorders, ADHD, Dyslexia, Processing, Written Output, & Speech Disorders and the family dynamics that often come with (e.g., Parental Fatigue, Depression, Anxiety, and Couple/Parental Dynamics). Over the years Dr. Swingle has found that that many symptoms, for which clients seek psychological services, appear to be exacerbated, if not caused by, excessive or otherwise inappropriate applications of interactive technologies (gaming, porn consumption, social media obsession etc.). This has been the primary focus of her clinical research since 2009.

·       Stuart Donaldson, Ph.D., EMTA, BCFE, ABDA Registered Psychologist, Director of Myosymmetries: Stuart received his Ph.D. from the University of Calgary in 1989. His doctoral work was on the relationship of muscle activity as measured by surface electromyographic (SEMG) techniques to chronic pain. He has utilized SEMG in studying myofascial pain, and fibromyalgia. Unique in the psychophysiology field he has also studied qEEG and brainwave activity combining SEMG with EEG biofeedback producing a comprehensive theory involving neural plasticity and fibromyalgia.  Stuart has published extensively on both myofascial pain syndromes and fibromyalgia. In 1995 he won the American Journal of Pain Management Award entitled, Outstanding Contribution to the Interdisciplinary Pain Management Literature, for his work on SEMG, neck pain and headaches. His present interests include the use of the qEEG in evaluation of concussions (mild traumatic brain injury) in the general population, including Junior A Hockey players. Dr. Donaldson is currently conducting a 4-year study of concussions in junior hockey with three papers published to date. The clientele seen at Myosymmetries includes mild traumatic brain injury (usually post motor vehicle accidents and sport injuries), anxiety and depression, ADD, post-traumatic stress disorder (PTSD), and more. Stuart continues to travel and lecture throughout North America, and is presently Director of Myosymmetries, Calgary.

 

BOS36 Biofeedback and Neuromodulation-modalities: A Personalized Approach, Applicable to a Culturally Diverse Population
Time: 5:15pm-6:15pm
CE Credits: 1
Track: Hot Topics
Level: Introductory
Session Focus: 100% Clinical
Target Audience: Those who are new in the field, clinicians or those interested in applied clinical research.

Personalized approaches to healthcare delivery have been highlighted in the clinical and research literature. Starting in biomedicine, with personalized medicine, and evolving into a multi-factor framework that includes, genetics, brain structure/function, cognition, psychological and personal factors. Personalizing protocols in healthcare delivery take into account that psychophysiological, cultural variability exists among a diverse population of individuals, which plays a clinically significant factor in their care and recovery. In clinical work, a personalized approach, not only positively influences the prescriptive nature of the (health) intervention, but also its course and efficacy. Biofeedback and neuromodulation-modalities lend themselves to a personalized approach aligned with P4 medicine tenets; keying on customized protocols targeting individuals’ (markers) baseline functioning towards their optimal zone of functioning. To deliver personalized, customized protocols, is important to be informed on the science, modality, ethics and clinical best practices involved. Representative deidentified case samples and protocols will be presented.  

Learning Objectives:

·       Describe 3 key aspects of Biofeedback as a personalized approach.
·       Explain differences in prescriptive-personalized protocols, in a culturally diverse population; and
·       Identify 2 Biofeedback prescriptive-personalized protocols.

Speaker(s):

·       Genomary Krigbaum-Pérez, PsyD, BCB, DAAETS, FAAPB, LP, Clinical Assistant Professor, University of Wyoming Family Medicine Residency Program: Dr. Krigbaum-Pérez is a psychologist and Clinical Assistant Professor at the University of Wyoming Family Medicine Residency Program, with keen interest in applied psychophysiology and biofeedback/neuromodulation modalities. She is invested in clinical work, applied research, training future clinicians, consulting and scholarship. Her work encompasses cross-cultural neuroscience and evidence-based (-informed) interventions/frameworks. Dr. Krigbaum-Pérez is passionate about fostering as well as promoting individual resilience, and quality of life.

 

BOS37 Resilience Training with Mindfulness and Biofeedback
Time: 5:15pm-6:15pm
CE Credits: 1
Track: Clinical Interventions and Optimal Performance
Level: Intermediate
Session Focus: 70% Clinical/30% Research
Target Audience: Individuals in optimizing health and performance.

Performance environments today, whether on the field of a competitive baseball game or at the board room of a Fortune 500 company, are often uncertain, complex, volatile, and demanding.  Whether your team is overcoming adverse conditions for a championship tournament or you get passed over for a promotion, many scenarios could threaten to derail your mood, focus, and performance.  Resilience is fundamental to successfully navigating those inevitable challenges in sports, business and life.  During this 60-minute symposium, Drs. Inna Khazan and Leah Lagos will identify four strategies to help your clients cultivate resilience and perform at their peak during times of uncertainty and challenge.  Fortunately, resilience can be learned and, not surprisingly, can be achieved through deliberate practice and planning.  Drs. Khazan and Lagos will ask questions like, “how do you train your mind to become more resilient,” and “what specific HRV strategies can build resilience during critical performance moments.” They will also address matters such as how sleep impacts resilience and recommend specific cell phone apps for training resilience in between critical moments.  With more than two decades of combined experience working with athletes around the world, musicians, artists, doctors, and business professionals, Drs. Khazan and Lagos will teach how deliberate, intentional efforts to cultivate resilience can help performers achieve success.

Learning Objectives:

·       Discuss concepts of sleep, mindfulness, HRV and their relevance to resilience.
·       Identify frequent sleep challenges that high performing individuals face and recommend specific applications for improving nocturnal HRV.
·       Observe and experience specific HRV biofeedback techniques for improving the ability to return to quickly baseline following a stressor.
·       Learn specific cell phone apps that can be utilized to improve and/or train resilience.
·       Experience how these biofeedback-based skills can be used to effectively and quickly improve resilience.

Speaker(s):

·       Leah Lagos, Psy.D, B.C.B, Licensed Psychologist and Board Certified in Biofeedback: Leah Lagos, PsyD, is a clinical and sport psychologist and BCIA Board Certified biofeedback provider in Manhattan, New York.  She earned a doctorate in clinical psychology from Rutgers University and served as a faculty member of the Center of Alcohol Studies at Rutgers University.  Highlights of her work with athletes include conducting interviews for NFL teams, as part of Professional Sports Consultants, for more than 9 years. Dr. Lagos has served as a consultant to PGA tour players to provide on-site support at tournaments such as the Masters' Tournament in Augusta, GA. Dr. Lagos has also served as a consultant to US Olympians providing consultation and on-site support at venues such as the London Olympics.  As a consulting psychological expert for the media, Dr. Lagos has appeared on the Today Show, NBC Nightly, MSNBC, CNN, CBS, Fox, Sports Illustrated News and ESPN.  She is a consulting editor for Biofeedback Magazine: Clinical Journal and was the Guest Editor of the 2015 spring issue.  She is the Co-Chair of the Optimal Performance Section of the American Association of Physiology and Biofeedback and a Guest Editor for Biofeedback Magazine.  Dr. Lagos is also an appointed biofeedback provider for athletes and patients of several hospital programs

·       Inna Khazan, Ph.D., BCB, Licensed Clinical Psychologist Certified Biofeedback Specialist: Inna Khazan, Ph.D., BCB is a faculty member at Harvard Medical School, where she has taught biofeedback and supervised trainees since 2008. A clinical psychologist specializing in health psychology and biofeedback, Dr. Khazan also maintains a private practice in Boston, working with clients on optimizing their health and performance, using biofeedback and mindfulness based approaches. She has been invited to give keynote and conference presentations and teach workshops at national and international conferences on the topics of biofeedback and mindfulness. Dr. Khazan has conducted biofeedback and mindfulness trainings for notable institutions in the US and abroad, including the US Navy Special Warfare and the Stuttgart Opera and Ballet Company. Dr. Khazan is recognized as a pioneer in the area of mindfulness and acceptance based biofeedback, and is the author of a highly regarded Clinical Handbook of Biofeedback: A Step-by-Step Guide to Training and Practice with Mindfulness.

 

BOS38 Heart Rate Variability Biofeedback for Pain, Stress, Fatigue, and Depression among Veterans
Time: 5:15pm-6:15pm
CE Credits: 1
Track: Clinical Interventions and Optimal Performance
Level: Intermediate
Session Focus: 33% Clinical/67% Research
Target Audience: Everyone interested in clinical applications of HRV Biofeedback

Pain is a primary reason why United States Veterans seek medical care. It is often accompanied by a cluster of symptoms associated with increased sympathetic nervous system activity, including stress, fatigue, sleep disturbance and depression. Chronic pain induces a stress response, which in turn exacerbates pain, thus generating a self-perpetuating cycle of pain symptomatology and autonomic dysregulation. Heart rate variability biofeedback (HRVB) training induces a state of HRV coherence, a condition that maximizes HRV and facilitates cardiorespiratory homeostasis, improved autonomic health, and reductions in subjective symptoms.   Methods. This randomized, sham-controlled, intervention trial tests the hypothesis that HRVB can improve HRV coherence and alleviate pain, stress, fatigue, sleep disturbance and depression among Veteran patients with chronic pain. Participants are randomized to a previously established HRVB or sham protocol (target n=40 per group, total planned enrollment N=80). Each patient completed a baseline assessment, 6 weekly training sessions, a post-training assessment, a booster training (with an assessment, 1-month post-training), and a follow-up assessment (2-months post-training). Primary outcomes included: 15-minute HRV recordings (HRV Coherence Ratio), pain, and stress. Secondary outcomes include pain catastrophizing, fatigue, sleep quality and depression. Each participant was provided with a portable, data-logging HRVB device to monitor and evaluate treatment compliance and sustainability.   Results: A total of 116 Veteran patients were enrolled, 86 have completed the post-training assessment, and 76completed the entire protocol. In preliminary analyses, patients in the HRVB group had elevated HRV Coherence Ratios at the post-training assessment relative to baseline (0.24±0.04 vs. 0.78±0.1, respectively, n=42, p<0.001), whereas no change was observed among the controls, which indicates receipt of intervention by the treatment group.  At the follow-up assessment HRV Coherence Ratios remained elevated relative to the baseline assessment (0.65±0.11 vs. 0.24±0.04, respectively, n=34).  At baseline, scores for pain, stress, pain catastrophizing, fatigue, sleep quality and depression were well-correlated (all r’s: 0.56 to 0.86, all p<0.05  Results from mixed effects statistical models testing study hypotheses will be presented at the meeting.  Conclusion. Therapies that reduce opioid dependency would be a significant benefit to those with chronic pain. HRVB is a valid, quantifiable, easily implemented, non-pharmacological procedure. This study is directly responsive to the national VHA/DoD Task Force’s recommendations to provide complementary, integrative therapies for pain management among Veterans.

Learning Objectives:

·       apply prinicples of HRV and HRV Biofeedback to causes of chronic pain
·       assess the methods of determining clinical outcomes of HRV Biofeedback in a sample of Veterans with chronic pain
·       describe the utilization of HRV Biofeedback in controlling acute pain;

Speaker(s):

·       JP (Jack) Ginsberg, PhD, Columbia VA Health Care System: Dr. JP (Jack) Ginsberg, PhD holds appointments as a Licensed Clinical Psychologist / Neuropsychologist and Research Health Scientist at the Columbia VA Health Care System (formerly the Dorn VA Medical Center), as Basic Science Research Assistant Professor at the USC School of Medicine, and as Adjunct Assistant Professor in the Department of Exercise Science of the USC Arnold School of Public Health, all in Columbia, SC. He is an advocate for integrative management of PTSD and chronic pain using Autonomic Self-Regulation as a mind-body treatment. He has authored or co-authored more than 30 peer-reviewed scientific publications and served as a scientist reviewer of research grant proposals to NIH, VA, and DoD. He has edited and reviewed numerous published scientific articles.  Dr. Ginsberg has been a Principal Investigator and Co-Investigator on research grants funded by DoD, NIH, and the VA

 

CLOSING RECEPTION - INTERACTIVE CONNECTIONS
Time: 6:15 pm - TBD

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