Observations placeholder

Beyond Biofeedback – Drs Elmer and Alyce Green

Recently we have begun clinical research with a few patients referred to us by Menninger doctors for biofeedback training. We have worked in an exploratory way with two heart patients, both of whom received help from training. The following is not a report but simply the story, in some detail, of the treatment and response to treatment of one of these patients. I hope that such an account, not to be found in professional journals, may prove to be both enlightening and useful.

The patient was a woman with tachycardia and erratic heartbeat who came to see me in February of 1975.  She had seen Biofeedback: The Yoga of the West, a film about our study in India of a number of yogis who displayed unusual physiological controls and our research in our laboratory in Topeka, demonstrating that self-regulation of certain physiological processes can be gained with the aid of biofeedback. "Maybe I could be trained to help myself," she said.

She told me that her heart rate was very high, normally about 100 to 110 beats per minute and racing at times from 120 to 150 beats per minute. (Normal heart rate is roughly 70 beats per minute.) This frightened her, as did the "extra" systoles (contractions) she sometimes felt. Before beginning training, she had had to be rushed to the emergency room as often as two or three times in a six-week period.

I explained to her that it would be necessary for us to have a referral from her doctor before we could accept her as a subject. I briefly discussed the rationale diagram  with her and outlined what the training procedure would be if the referral was forthcoming. We would begin with temperature training in order to relax the autonomic nervous system, the system which controls heart behavior, and add EMG training for general relaxation. After she had learned to use these relaxation techniques in times of stress, she could begin work with the heart-rate feedback meter, practicing direct control of heart rate, learning to slow and speed her heart at will.

The referral from her doctor was received, and we started with the temperature trainer, teaching her to increase the warmth in her hands (which means, of course, increasing the blood flow to the hands). This necessitates relaxation of the autonomic nervous system-turning off the fight-or-flight pattern. After two sessions she took the temperature meter home with instructions to practice twice daily, recording beginning and ending temperatures and her answers to questions regarding her experiences during each session.

She soon learned to warm her hands from approximately 82 o F to around 90 o F, and later from beginning temperatures of 85-90 o F to about 95 o F. When she was proficient in warming her hands I suggested that she transfer the thermistor first to one foot, then to the other, increasing circulation to her legs and feet. She could soon feel the increase in warmth in her thighs-which she said had a tendency to be cold-and in her feet. After about four weeks of training she reported that she no longer needed to have a hot water bottle at her feet at night. During this time she also came to our lab twice a week to practice relaxation of the frontalis muscle in the forehead with the EMG trainer. The relaxation usually generalizes to the rest of the body, and she learned to relax very deeply. In addition to working with two biofeedback machines, she used some breathing exercises and Autogenic Training relaxation and warmth phrases whenever she felt her heart reacting to hurry or stress.

This patient cooperated beautifully and took an interest in making herself well. During March her reports indicated that she was able to use her training in many ways. A brief use of the breathing and relaxation techniques helped her control her pulse rate and handle pressures of hurrying and of parties and other social engagements. By nature an emotional person, she told of handling various reactions in calmer ways, having "a better temper." She reported waking at three o'clock one morning with a very severe headache. She sat up to reach for some medication on her night stand, then thought, "No, I'll use my exercises." In twenty minutes her headache was gone; she slept soundly and wakened refreshed.

This woman and her family had come to Topeka from a home "by the mountains and the sea" in a foreign land. She has been able to deal with old memories of her home and times there (such memories often flood up during deep relaxation) without undue emotion. More recently she has been re-experiencing happy memories of her family here, "good times with sun and in the garden." Such images come when she feels "between awake and asleep." On her record sheet she wrote, "I wanted to sing, I felt happy."

On April 10 she reported that she had seen her cardiologist and that the condition of her heart was improved. He was pleased that she had not had to go to the emergency room since starting her training. She told him that she could intentionally slow her heart, but when he said, "All right, show me," and placed his fingers on her pulse, she thought, "What have I done? Now I am frightened, how can I slow my heart?"

She closed her eyes and thought, "Body, don't go back on me now," took several deep, even breaths, and then began repeating silently, "My heartbeat is slow and calm, my heartbeat is slow and calm." Soon he stopped her, saying, "Yes, you are slowing your heart rate."

In spite of the challenging situation, she had succeeded. Through the remainder of April she became increasingly aware of being able to handle her heart problem, expressed in such ways on her record sheet as "Extra systoles before my temperature training. I was afraid. I thought to calm down and I did it." Another time: "I have my pulse very high when I begin and I succeed in slowing it." One comment was amusingly Americanized: "I was uptight but felt loose afterwards." Some comments indicated awareness of psychological change: "I'm beginning to face my ideas and feelings" and, again, "This is useful for me. It makes me know myself, not only muscles and body, but also my mind."

Her relaxation sessions at the laboratory were also successful, the EMG feedback meter showing after several weeks of training that frontalis muscle tension at the beginning of her sessions was generally quite low and at the end of a session was lower still. Soon she no longer needed to use the temperature and EMG biofeedback meters. She was aware of and had internalized the subtle changes necessary for voluntary control.

In May, three months after beginning to learn self-regulation through relaxation, she began working with the heart-rate meter. Her heart rate away from the laboratory averaged eighty-five to ninety beats per minute. She practiced alternately slowing and speeding her heart in order to get an increased feeling of self-control. During practice sessions she was able to slow her heart rate into the low-seventies range. Her doctor decreased her medication slightly, and she was hopeful that at her next visit he would see enough improvement to decrease it further.

This patient is a prime example of something biofeedback researchers talk about but seldom put in their professional publications. As expressed by many patients or subjects:

"Biofeedback has changed my life."

Before beginning her practice session at the lab one day she said, "I must tell you something. Biofeedback has changed not only my emotions and my body, it has changed my mind," and she told the following story.

Her husband, an important official in his company, had invited the president of the company and his wife and a few other important guests for Saturday-night dinner. In the discussion that followed dinner the president of the company had suggested a way of handling a policy matter that she felt was unwise. And then she did something that she said she never would have done before: She entered the conversation and calmly discussed her feelings, which she felt were shared by many others in the organization, and suggested an alternate course.

“My husband looked at me with such surprise!" she said, but her idea was well received and he was pleased. Without the "confidence of myself" gained from biofeedback training, she said, she would not have been able to express herself as she did.

One day she surprised me by saying she was no longer afraid of death. When her heart raced and beat irregularly, she had been terrified of dying; now she was not afraid.

Shortly after the dinner episode she came to see me, not at her appointed time and in great excitement. "Now look what biofeedback has done!" she said.

Amused, I asked, "What has biofeedback done now?"

"Just by chance," someone, seeing this bright, attractive woman and hearing her charming accent, had offered her a job, and she had accepted. "Never without biofeedback," she said, would she have done it. Feeling a bit concerned, I asked if her doctor knew. "Oh, yes, and he said, 'Go ahead.' "

I explained again what I had often explained before: that whatever had been accomplished in her had been accomplished by her, that biofeedback instruments are just sophisticated mirrors that show us how we are doing when we try to make certain changes, and that when we've learned how to make the changes we don't need the mirrors any more.