Alyce Green

Biobehavioral treatment of essential hypertension: a group outcome study.

In a group outcome and follow-up study of 77 patients with essential hypertension, significant reductions were seen in systolic and diastolic blood pressure (BP) and in hypotensive medication requirement. A multimodality biobehavioral treatment was used which included biofeedback-assisted training techniques aimed at teaching self-regulation of vasodilation in the hands and feet. Of the 54 medicated patients, 58% were able to eliminate hypotensive medication while at the same time reducing BP an average of 15/10 mm Hg. An additional 19 (35%) of the medicated patients were able to cut their medications approximately in half while reducing BP by 18/10 mm Hg. The remaining 4 (7%) medicated patients showed no improvement in either BP or medication requirement. Similar reductions in BP were seen in initially unmedicated patients. Seventy percent of the 23 unmedicated patients achieved average pressures below 140/90 mm Hg, with an additional 22% of these patients making clinically significant reductions in pressure without becoming normotensive, and with 8% unsuccessful at lowering pressures to a clinically significant extent. Follow-up data available on 61 patients over an average of 33 months indicated little regression in these results with 51% of the total patient sample remaining well-controlled off medication, an additional 41% partially controlled, and 8% unsuccessful in lowering either medications and/or blood pressures to a clinically significant extent.

Biofeedback for Mind/Body Self-Regulation: Healing and Creativity

As people in this audience know.* the revolution in consciousness we are now talking about was foretold a long time ago. It was thought of as the time when the sleeping giant, humanity, would awaken, come to consciousness, and begin to exert its power. British medical people began to get an inkling of the power of consciousness as long as 250 years ago when they began to study certain Indians who could do some very unusual and interesting things. These people, called yogis, apparently had phenomenal powers of self-regulation, of both mind and body. Of course, medical doctors as a whole did not believe it, but as the decades passed and reports became more numerous, some British and European physicians began the study of mind/body relationships. By the end of the 19th century the physiological phenomena of hypnotism, spiritualism, and various yogic disciplines had attracted some serious medical and philosophical attention, and by 1910 of this century, a mind/body training system, eventually called autogenic training (self-generated or self-motivated training), had begun to be developed by Dr. Johannes Schultz in Germany. This was at approximately the time that Freud gave up the use of hypnosis as a medical tool because it was unpredictable. It occurred to Schultz that perhaps hypnosis was an erratic tool because the patient often unconsciously resisted the doctor. If the patient were able to direct for himself the procedure being used, with the doctor acting as his teacher, then the control technique would come into the realm of self-regulation and perhaps be more effective.

BIOFEEDBACK TRAINING FOR ANXIETY TENSION REDUCTION

Biofeedback is defined as the immediate ongoing presentation of information to a person concerning his own physiological processes. A patient looking at his own ongoing electrocardiographic (EKG) record is, by definition, getting biofeedback; if he trys to manipulate the heart through internal processes in some way while watching his record, using EKG feedback for guidance, he is trying biofeedback training. Feedback for control of the striate muscles (voluntary nervous system) is the way in which every skill is learned-driving a car, for example-but it was not recognized until recently that the autonomic (involuntary) and central nervous systems could be self-regulated to a significant degree with the aid of biofeedback. In some way that is not yet ful ly understood, immediate knowledge of results develops awareness of normally undetected (normally unconscious) existential cues whose manipulation results in the changes desired. It should be noted that this process of control includes striate behavior. N o one really knows how any volitional act is accomplished. All we know is that as babies we begin to practice controlling the striate system (probably because feedback is always available), but it is still unknown how we move our hands from one position to another. We visualize what we wish to do, give the “command” (whatever that is), and the act is carried out . Autogenic feedback training for self-regulation of temperature (blood flow) has already been shown to be clinically effective in many patients in control of migraine headache.’,‘ Raynaud’s disease, a deficiency of circulation in pcripheral parts of the body, also has been reported in pilot work to yield to temperature training.”,’ Tension headache yields to electroniyographic (EMG) feedback training,” and a host of cardiovascular studies is showing promise for clinical control of a number of cardiac disabilities and hypertension.”.” Very recently Sterman and Friar“ have shown that epilepsy may be brought under control through EEG feedback training for elicitation in the sensory-motor brain region of a 12-14 Hertz (cycles/second) rhythm, and Poirier”’ has reported self-regulation of epilepsy through training of alpha rhythm (8-13 Hz) in the occipital portion of the brain. Although the foregoing reports of biofeedback research and application involve the use of specific physiological signals for the self-regulation of specific identifiable somatic or psychosomatic disabilities, some biofeedback training is especially useful in combatting generalized anxiety tension reactions. Haugen, Dixon, and Dickel” showed that a relaxation program aided on occasion by EMG feedback was useful in training patients to handle their own tension reactions, eventually “turning them off’ without drugs. It is interesting that the described psychiatric problems were often solved in the process. Recently Paul