Tag Archives: Biofeedback

206. Coping with Virus Fears

17 Mar

The rapid spread of Covid-19 virus has triggered fears in many people, and fear can be dibilitating.  I watch a lot of news programs, and I am disappointed to see the promotion of ineffective stress-reduction programs. In my earlier days I was a licensed PhD clinical psychologist, and I am going to briefly present ideas here (not medical advice), which may be of help. There is a general value to learning the control emotions and limiting fears. Here are some important ideas, which are just an introduction to this topic.

Stress, anxiety, and fears have a basic physiological factor, which evolved for survival. The main organ controlling this is a branch of the autonomic nervous system. It is also known as the “fight-or-flight” system, which prepares us for a vigorous defense. This system involves higher heart rate, muscle tension, blood flow changes, sweating, etc.

Fight-or-flight changes are activated by real danger, or simply by fears. Many will notice this activation and identify it as anxiety or stress. It leads to “worry.” Once triggered, the activation (anxiety) can last for hours or days beyond the original stimulus. The activation itself can be stressful and can lead to even more of these changes. (Technically, this is a positive feedback loop, i.e. feedback causes something to increase.) The end result of increased activation can be a panic attack.

Stress and anxiety must first be treated by normalizing this defensive system. Relaxing the body will cause the brain to relax. Starting therapy by working with fearful  thoughts is not effective, because they will always occur when the fight-or-flight system is activated. The procedures involve relaxing many muscles and breathing peacefully.

A “relaxation tape” or therapist can provide instructions for this process. Once a method is learned, it can be implemented in just a few seconds. Also important is awareness (feedback) of muscle tension and blood flow changes. Many people live much of their adult life, unaware of excessive, energy draining, activation. If a therapist is used, very effective “cognitive” discussions can be added later. Also a part of the process is learning to breathe peacefully: generally, regularly, slowly, and deeply.

If a person is presented with relevant measurements (scientific facts) he/she can learn more quickly. When scientific, medical instruments are used, the therapy method is called “biofeedback.” The feedback could be heart rate, hand temperature, a measure of sweating, or blood pressure, usually presented with a changing sound. For example, hand temperature will rise as one relaxes. A transducer and some electronics can convert this temperature into a sound. As temperature rises, the pitch can rise and the patient gets helpful information.

Having taped instructions for the relaxation process is a good way to start. You can go to the Internet and do this search: “muscle relaxation tapes.” Here is a good one:
.                 https://www.youtube.com/watch?v=86HUcX8ZtAk
After using the tape a number of times, the relaxation procedure can be shortened. Eventually, a “brief relaxation response” can be developed, which takes only 10 to 15 seconds and can be done almost anywhere. Note that these behavioral methods provide an actual, direct cure, while many other methods provide something temporary, which must be used indefinitely. As you learn the relaxation methods, much of the process becomes automatic and less attention is needed. Take whatever actions are required for the virus, and deal with any associated fears in this enjoyable way. Entering a state of peacefulness is a remarkable experience.

 

30. Stretching Program for Back Pain

15 Nov

In a previous blog (July 17, 2015, Number 23: Treatment for Common Back-Pain), I described a treament for lower-back-pain with muscle strain as its basis. This blog, Number 30, will cover subsequent observations and information.

I suggest that the immediate cause for most lower back pain is excessive muscle tension, even if there is an ultimate, responsible, spinal defect. I have drawn this conclusion after many years of scientific research, work with patients, personal experience, and a Ph.D. program specializing in physiological psychology and neuroscience. My own severe back pain motivated me to spend hundreds of hours studying the spine, MRI scans, back muscles, and various treatments. Professionally, I was the recipient of a government research grant from NIH, and was head of a research department (Neurological and Behavioral Sciences) at Henry Ford Hospital, Detroit.

CAUTIONS
Before continuing, I want to emphasize that consultation with Medical professionals (MD or DO) is often necessary, that I am not providing “medical advice”, and that in using the procedures described below, one must avoid rapid, sudden, and angular movements that could cause additional problems. My program is most applicable to those with centered, lower back pain, as opposed to pain that is on one side, and/or radiating down one leg (often designated as Sciatica). But even if the spine has known defects, such as a herniated disc or neuroforaminal stenosis, muscle tension may be the immediate cause of pain. One must work slowly and thoughtfully, advancing the stretching little-by-little.

DIAGNOSIS
The result of my study of the medical literature and experience as a psychotherapist (specializing in stress-reduction) and as a patient, leads me to believe that the precise source and origin of the pain is often unknown. CT and MRI scans are helpful in determining spinal damage, but there can be hidden damage not detectible by scans. The bony and supportive structures (such as discs), in the spine have no pain receptors and damage to these does not directly cause pain. Pain caused by the spine comes from defective spinal structures that press or squeeze the main cord or emergent nerves. For example, squeezing of the sciatic nerve as it emerges from the spine can cause “sciatica” (pain in the back, which radiates down the leg). A final diagnosis emerges from medical history, physical examination, scans, and dialogs with the patient. “Discograms” are often needed to pin down the specific location where squeezing occurs. A discogram includes an invasive probing of the suspected spinal areas and reports of the unanesthetized patient. If probing in a certain area produces the sensation of the patients back pain, then that will be the area corrected with surgery. In the end, surgery is often performed with a less than 100% confidence in the diagnosis. It is understandably difficult to work with a complex living structure buried deeply below the surface of the skin. A more definitive procedure such as a discogram is often avoided by patients because it is painful.

Abnormal pressure on a spinal nerve may be the cause of back pain, but the cause can occur in different ways. First, there could be a direct cause: pressure causes sensory nerve impulses that are interpreted by the brain as back-pain. An indirect cause could be that certain motor output to back-muscles is greatly increased causing excessive muscle tension. It is a known fact that excessive and prolonged contraction of any muscle can cause pain and even severe cramping. The affected nerve could also interfere with reflex systems located in the spine that regulate supportive muscle tension. In my case, sleeping in bed always resulted in very tense painful back muscles. My sleeping position may have caused certain forces on the spine that affect important regulatory reflexes. For me, the biggest question is what causes the profound contraction while sleeping?

Of course back pain can occur without any defect in the spinal cord or emerging nerves. For example, a dentist needs to bend forward and perform very delicate and often difficult procedures. This situation requires back tension to support the required movements. While the dentist is operating, the back is very tense. Unfortunatly, the tension may persist after the procedures are finished. Other stresses, such as concern about cash flow, a law suit, various personal problems, etc. can make the tension worse. The work performed in many professions and in other situations can lead to back muscle tension. A computer programmer can sit for hours in front a computer trying to “de-bug” an important program. Working while sitting very still for hours can lead to severe and painful contractions (also in the legs and even fingers). Any activity that requires a considerable amount of time bending forward (or even sitting still) can tax the supportive back muscles. The fact that after the taxing activities are finished, the muscles may not resume a comfortable, fully relaxed state, is critical.

THE STRETCHING PROGRAM
Who should try the stretching programs described here? Before continuing, I want to re-emphasize the “Cautions” listed above. If you think that stretching your back muscles could possibly produce more damage, then consult with a medical specialist before experimenting.

This program could benefit anyone with lower back pain resulting from any cause. The safest application would be after an examination by a physician who finds no specific spinal involvement. If there are spinal defects and/or pain on one side, then be more cautious. In the end, the patient must make a final decision, which is always a kind of gambling and weighing of benefits versus risks. My own inclination is towards self-help, but I definetly value the input of established experts. In most cases, I have been correct, but a couple of times I have made serious, but not lethal (as you have already guessed) errors.

My blog 23 has a good description of the stretching procedures. What I will do here is to emphasize the important points and further observations. Many years ago, the benefits of “toe touching” exercises was established. I recommend doing this many times a day, at least hourly. Also, it should be done before and after certain activities, such as sleeping, napping, sitting at a desk, doing anything stressful or requiring concentration, carrying heavy objects, many types of physical work, etc. Experimenting is key to success. A single repetition is to bend over (standing or sitting) and try to touch the toes. Use a moderate amount of effort, too little would be ineffective and too much could be harmful. After bending, resume an upright position. Do at least three bends, without pausing, or with pauses of a few seconds. It is very important that you continue until you achieve a maximum bending. Experimenting will tell you how many reps are necessary to fully stretch the back muscles. As you work with the back muscles, you may be able to alter or abidge the procedures so that less time is taken. While writing this lengthy blog I moved in various ways so as to feel if tension is building up. Twice I fully bent over from a sitting position. Finally, I want re-emphasize reaching maximum bending, because, my experience is that failure to do so will allow pain to persist.

FEEDBACK AND LEARNING
Maybe the most important contribution I can make here is to describe the feedback and tension-gauge that is very helpful. You can better achieve any goal by “seeing” the actions, developing a gauge, and understanding the process. Biofeedback instruments are often used to combat tension and stress. Biofeedback can help, but it is difficult to locate and study the many and deep supportive back muscles. Earlier in life I saw many patients for stress using biofeedback methods.

A really good way to gauge back tension is the following.
1. Establish a standard bending procedure: use a specific chair or standing posture.
2. Perform at least 4 or 5 bending repititions.
3. Your current measure of back tension is the difference between the first and last amount of bending. The “bending amount” is the distance from finger tips to floor.
4. If you can muster the motivation, record the activity and the tension gauge.

Here is an example. You are sitting on the side of your bed and a moderate effort on the first bending results in your finger tips reaching a point 3-inches above the floor. The second time you bend, you reach 1.5 inches from the floor. Third and fourth bending are one-inch and 1/2 inch. Several more bendings are 1/2 inch away.
The tension gauge is 2.5 inches (the first, 3-inches minus the last: 1/2 inch). I have already done this procedure hundreds of times. If you easily touch the floor when bending (using your standard procedure) then you can measure the distance from your wrist or knuckles (making a fist) to the floor. The gauge is always the difference (in inches-to-floor) between the first attempt and last. As you work on this, your will quickly learn what is your maximum stretch and can stop the reps at this point. Think about what you are doing and what the muscles feel like when tense and fully stretched.

Here are some details of my personal experience. I have two standard positions: one is standing-up with legs straight and feet separated by about 18-inches, the other is sitting on the side of my bed. When I wake up after several hours of sleep, my back is very tense. First bend from a sitting position is about two-inches above floor. The last (after 4 to 6 bends) and best sitting bend is to palms on floor. The difference is five-inches. Five inches represents the current tension. That is a maximum for me. A long sleep always results in a “five” even though I fully stretch before entering bed. A short sleep or just resting in bed produces a lesser amount. Working at the computer, depending on the activity and intensity can produce tensions ranging from about one-inch to four-inch toe-touching differences. Various types of movement tend to lessen the tension. Being still for a long time increases the tension. My overall max is the five-inches. For me, walking around with a five-inch tension level can produce severe stabbing pains and a feeling of collapse. Several years ago, I realized that a few stretches before standing up was helpful, but I did not realize the full picture. Unfortunatly I never saw the importance of stretching at other times, particularly before sleeping. Although I always wake-up with back tension, I suspect that stretching before getting into bed helps to produce a more relaxing painless sleep.

FINAL THOUGHTS
If you study and experiment you may be able to avoid expensive and painful medical procedures. On the other hand, there are times when good medical advice is really necessary. I wish I could define these times with 100% accuracy. If you have unusual back-pains or severe back pains consult with a well-established and credentialed orthopedic doctor. If other symptoms accompany the back pains, see the doctor. I have not yet mentioned inflamation. Any severe painful condition may be accompanied by harmful inflamation. There are numerous drugs and natural remedies for this. I take two common NSAID anti-inflamatory pills early in the morning. I experimented with tumeric, but for me this was of little effect. When I cured the severe backaches with stretching, I totally stopped taking the NSAID. But after about 10-days my knees started to hurt more, so I resumed two/day.  I suspect this also helps with any back-muscle inflammation.

Here is another factor that comes to mind. General good health achieved through diet and the right exercise can be of benefit. Fourteen years ago I developed a moderate sciatica, which disappeared after about two months. I had an MRI scan and noticed that the report mentioned dessicated (dry) spine. I discovered that Vitamins A and D were missing from my diet and I restored these factors. The pain disappeared in about two months, and the vitamins may well have been the cause.

23. Treatment for Common Back-Pain

17 Jul

The basis for a back-pain condition is often unknown. I have discussed some aspects of this in my previous blog number 22. The most common source is some type of muscle strain or damage. The pain can also be caused by a spinal defect. Medical advice should be obtained from a physician.

The treatment I am concerned with here, is for the most common source of back pain: muscles that are excessively contracted for prolonged periods of time. As a psychologist specializing in stress, I have seen many patients with back-pain. My work with patients was many years ago, but more recently, I have had a severe back-pain condition, and this stimulated research and experimentation.

I am going to describe in detail, a method that cured my pain and is consistent published medical and therapeutic research. Note that my spine has numerous defects (as revealed by an MRI scan), but simple muscular relaxation procedures have provided complete relief. Note also that from time-to-time I have taken the anti-inflamatory drug naproxen, which does not seem to be key, but probably is helpful. I also take calcium and magnesium supplements, which are known to help with muscle cramps.

THE TREATMENT
I am going to describe a simple method that anyone can perform. The basic method is to frequently stretch the back muscles and observe the tension. Of course, there is nothing new about the idea of stretching, but the feedback concept I use, may be novel. The back-muscle stretching is done by bending over and touching the toes. It can be done standing or sitting. To be effective, it must be done many time per day – say 20 to 40 times, and three to five bends in one session.

Before continuing, I will suggest some precautions:
1. Bend slowly and without any twisting. Sudden bending can cause damage.
2. If careful bending causes substantial pain, you should see a doctor.
3. If the pain is more on one side than central and/or radiates down a leg, it is likely that the spine is involved and medical examination is needed.

The stretching procedure should be done before and after any activity, including physical working, computer work, games, cooking, gardening, watching TV, etc. Before and after sleep is very important. Sleep should be relaxing, but often involves considerable tension. If you are in a social situation where stretching is difficult, you can move around in certain ways to detect tension. This alone may help loosen the back muscle, or if very tense, do some major stretching in some private area.

THE FEEDBACK
A brief session of stretching should consist of about four bendings to touch the toes. This will only take about 10 to 15 seconds so anyone will have time to do this. The feedback is related to the difference between the first and last stretching. For example: the first stretch only reaches (without straining) to a point four inches above the floor. Each successive bending brings your fingers closer to the floor — the fourth is one inch from the floor. The difference is three inches and this is a measure of the built-up tension. The greater the difference, the more tension has accumulated during the previous activity. As you do a variety of activities you will be able to gauge the tension that each activity (or immobility) has produced. For people with back-pain, this tension tends to build up through the day (and often during sleeping) and can lead to serious pain, unless you do the frequent stretching procedure (or equivalent). My experience is that pain medication alone is not sufficient.

Why is feedback so important? Because the better you understand something, the better you are able to control it. Also, the frequent stretching and tension-observations can lead to improvements in automatic control — improving the body’s natural regulation systems. If you work conscientously on the stretching procedures for three or four weeks, you may be able to cut-down on the time spent in this process. For example, I have found that when working on the computer, I can simply move around for 2 or 3 seconds in certain ways to diminish the tension. But after sleeping for several hours, I must carefully perform several toe-touching stretches. If you are going to lift something heavy or do something athletic, it is very important to stretch before doing so.

CONCLUSION
It is amazing how many of our problems can be solved by research, thought and experimentation. The above is a guide and you may be able to develop your own effective variations. You could also go to a specialist, such as a Ph.D. psychologist that utilizes “biofeedback.”

22. BACK-PAIN and CALF-TENSION

16 Jun

Postural muscles are those that help maintain standing and other positions. Important examples are in the lower back, calves, and hip. Since these muscles must be tensed for long periods to maintain our balance, they are often strained and become painful. My experience with very severe back pain and calf tension has inspired me to do a considerable amount of research. I suspect that most people really do not understand these disorders and that doctors often avoid explanations and/or do not fully understand the physiology. I have listed below some of my observations in this area.   Since this information is not presented as a substitute for medical advice, it may best serve to stimulate beneficial discussion. This information was developed from writings by reputable doctors, physiological psychologists, and other therapists. Some of it may be speculative.

It is often the case that tension in a muscle may persist long after necessary for its function. Sometime postural muscles are tensed when the tension is not necessary for support, or greatly tensed when only moderate tension is needed. Inflammation often results from excessive muscle tension, and may build up slowly. In my case, I suspect that the build-up has taken several days or maybe weeks. There is no pain during the build-up, but after a certain threshold is reached, a sudden sharp pain may appear after an ordinary movement. Perhaps at some point, the inflammation is so great that a ligament or tendon slips out of position triggering pain receptors.

Tension may be prolonged by psychological stress factors, chronic anxiety, and/or other reasons. There is tendency for medical doctors to ignore psychological factors, and more specifically, to attribute lower back pain to the spine rather than to muscle.  (This happened to me with disastrous consequences.)

One of my muscle-tension cases is instructive in this area.   I was referred by a doctor, a lady patient with right leg pain.  She had consulted with several physicians to no avail.  After an extensive interview and some tentative relaxation work, it became apparent that her pain was caused by the stress of driving many hours a day for her business.  We worked on a program of general and specific-muscle relaxation and her pain problem was quickly solved.

Prolonged tension in a muscle can lead to pain and in the worst case, cramping. Cramping can be identified by sharp pains, hard muscles, and often a brief collapse. If you have experienced a common calf cramp while playing tennis or other sports, you know what this feels like. What I find interesting is that you can also get similar cramps in the back muscle.

Sometimes the pain prevents beneficial stretching, as this temporarily makes the pain worse. For example, working with a computer for long periods, can lead to calf tension and if not relaxed can strain or damage the achilles tendon. If you are making precise computer mouse movements or are writing about something upsetting, many muscles may be over-tensed.

With regard to back-pain,  it is noted by experienced physicians that CT   and MRI scans may indicate serious spinal defects, but these may not be   the cause of the pain.  The source of pain must be determined by also considering physical examination,  history, and interview.

Treatments. There are a variety of treatments for postural muscle pains, including surgery, nerve blocks, physical therapy, etc. Since my education and practice is in physiological psychology, I am emphasizing that aspect.

If the cause of pain is excessive muscle tension, then the following is helpful. Awareness of tension often leads to a natural regulation. Awareness can be developed by focusing on a muscle, then repeatedly tensing and loosening it. What does it feel like when it is tense and loose? The simplest procedure to directly reduce tension is stretching. For back pain,  my personal experience is that bending over and touching the toes 30 or more times per day, is the single most effective action. For tension in the calf, standing and pushing against a wall to stretch the gastrocnemius muscle (like before running track) is best. You can also get benefit from massage, vibration, heat or cold, and inversion (hanging by feet) for backache. Biofeedback equipment can help with general and specific relaxation. I have successfully used this method with many patients.

Since inflammation is often involved in the pain, NSAID drugs, such as Naproxin can help, but may not be necessary. Inflammation itself can cause damage so it must be reduced.  If you use medication, you may need to consult with a doctor regarding drug interactions. If you use any medication it’s best to terminate when when the pain has abated — and you should terminate gradually.  If the pain has a cramp-like characteristic, one could consider taking mineral supplements, such as calcium and magnesium.

Generally,  it is important to avoid situations that promote inappropriate muscle tension. For example,  immobilization for a long period should be avoided. Just moving around is helpful. If you are sitting in a chair working with a computer you could get up periodically (say, every half hour or less) and walk around, or just sit there and do some arm, leg and back stretching movements. If anxiety or nervousness contributes to the tension, then psychotherapy could also be helpful.

Final thought: I am most concerned because some doctors over complicate a common pain problem and do not recommend an effective simple solution.  For lower back-pain, the patient could be instructed to stretch the back muscles (carefully) many times per day — and to be aware of what the muscles feel like and what activities may be causing tension.  For knowledgeable patients, scans and/or PT may not be necessary.  Many years ago, I went to an orthopeadic doctor at Henry Ford Hospital, for a severe achilles-tendon pain problem.  After an examination, his only recommendation was to stretch my calf muscles many times per day — a perfect and correct simple solution. How many doctors today would provide this simple answer?

Post 8. Psychotherapy and Science

24 Apr

The topics that I will discuss here could fill books, if properly explained. My main goal is to stimulate thought and an interest in behavioral science.  I want people to understand that there is scientific psychology and it has many applications, including a role in  therapy.

My major formal education was in the area of psychology and one of my major careers (about 20 years) was clinical psychologist. I went to the University of Maryland for my Ph.D. This department was strongly oriented towards the science of behavior and clinical methods related to this science. I also have a BS in physics, which makes me even more of a science advocate.

Having this background, and being a firm believer in the power and “rightousness” of science, I have often been disappointed by clinicians and neuroscientists who neglect or ignore the tremendous efforts put forth by many psychologists to make their field scientific. Why should psychology be scientific — because it is man thinking at his very best, and it is the best way to find truth. How do I know this? Well, consider the methods of other professions: politicians, religious leaders, evangelists, philosophers, poets, novelists, reporters, etc. Of all the professions you can think of, only one has a universally accepted method, and that is scientist. All established scientists are guided by principles such as: unbiased observation, replication of findings, free criticism, precise definitions, appropriate experimental designs, use of hard evidence, etc. Also consider that scientists have produced tangible results whereas others often produce nothing but words — and the words of different persons are often contradictory.

Science has brought us computers, TV’s, contact lenses, cures for diseases, automobiles, etc.; all of the technology that we enjoy. Some would say that science also brought us the dangerous atomic bomb. But science only suggested a possibility — the bomb was financially supported and produced by the decisions of politicians.

Behavior therapy uses the results of science to help people live better lives. Science looks at what people do and say, and has little interest in speculating about what the “mind” is doing. Note that what people say about their thoughts can be included in science, but the thoughts themselves are not generally observable and cannot be included. A “thought” can only be “detected” by the thinker, and science is limited to things that can be observed by more than one person.

Biofeedback

A powerful scientific method within the framework of behavior therapy is “Biofeedback.” This method makes use of physiological measuring instruments to provide useful training information to patients. The “feedback” is electrical signals in the form of sounds or visual stimuli. Lets take an easily understood example. A common complaint of patients with stress is headaches. Many headaches are caused by tension in neck and jaw muscles. Biofeedback can provide information about the tension in specific muscles using medical instruments. The patient can observe the feedback and can learn to reduce excessive and dibilitating muscle tension. Other biofeedback methods include information about heart rate, sweat gland activity, blood pressure, respiration, etc. Most of clinical biofeedback is concerned with reducing stress, nervousness and tension, and the physical effects of these factors. Disorders include anxiety, headaches, high blood pressure, digestion disorders, heart function, insomnia, teeth-grinding, etc.  Stated in other words, feedback (lights, sounds, etc.) provides information to a patient so that he can learn to control emotions like fear, stress, and anxiety — and their related physical disorders.

Biofeedback is a powerful, but under-used learning method. Most ordinary people who seek help for psychological problems have anxiety, or anxiety is a major component of some other complaint. The most direct method of treating anxiety is biofeedback, because the feedback makes anxiety “visible” and therefore easier to control. Biofeeback methods lead to “emotional control” — a key factor in mental health. Sometimes, the reduction in anxiety is all a person needs — but often people must also talk about relationships and other concerns.

Many psychotherapists work on curing the “mind” so that a person’s behavior and “feelings” can be adjusted and improved. However, in most cases, the cause-and-effect works in the opposite direction. Developing good behaviors and a well-controlled and relaxed body first, will lead to a “cured mind.” What we have found is that if you are feeling stressed, it is better to work on relaxing your body, than trying to alter your thoughts. Working on fearful thoughts is often frustrating because a tense body keeps generating negative-thought production. There is a an evolutionary reason for this to be discussed in a later blog. Working on relaxation and biofeedback methods breaks the patterns of negative thinking and stimulates more positive and relaxed thinking. The more one studies the relationship between his body and thought process, the better he does.

Biofeedback Under-used

This effective method, which has been popular from time to time has never been widely accepted. Here are the reasons. Since biofeedback is a learning process, it should be a clinical psychology method. But people going into the profession of clinical psychology often have little technical or scientific aptitude, which would be needed to effectively use the physiological measuring equipment. Physicians may discourage the use of biofeedback because it interferes with their practice of medicene. Much of medicene depends on the prescription of medicenes. Biofeeback is a behavioral method which makes many drug procedures unnecessary.

Final Thought

The science of psychoogy has been promoted at some of the most highly-rated educational institutions, such as Harvard University. Biofeedback has been researched and used by scientists at some of the most important clinics, such as the Mayo Clinic in Minnesota. There are extreme cases of mental disorders which do require the use of drugs and other methods. But for the common stress symptoms and disorders, behavioral methods and particularly biofeedback provide the most powerful and long-term solutions, without drug dependency and addiction.