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Biofeedback and Self Hypnosis Training
Patients are seen for individual cognitive-behavioral psychotherapy including biofeedback and hypnotherapy/relaxation training. Biofeedback training involves the use of sophisticated multichannel, computer based instrumentation for the monitoring and display of bodily signals in a manner that educates patients about their conditions and allows them to be trained in increased physiological self control. These signals may include: sEMG (muscle activity from various muscle areas which reflects habitual patterns of neuromuscular tension and muscle recruitment patterns), peripheral temperature (measure of relaxation and extremity blood flow), heart rate, autonomic nervous system activity and other physiological responses. At the first session, an initial assessment of muscle tension, peripheral temperature and autonomic nervous system response associated with pain is done. This evaluation may be done in the sitting, standing and/or other positions relevant to the pain problem. Following this assessment, targeted training is done to facilitate skills acquisition and behavioral rehearsal of mood, sleep and pain control skills. These skills include awareness of bodily tension, abdominal breathing, general as well as specific neuromuscular relaxation, symmetry of muscular response, reduction of excessive autonomic arousal, facilitation of increased blood flow and cognitive control of other responses. Ambulatory biofeedback units and tapes may be given to supplement individual sessions. Biofeedback can be used for a variety of pain problems as well as to provide objective psychophysiological measurements that monitor progress in learning relaxation and pain control skills.
Hypnotherapy is also used for training in pain and mood control. Hypnotherapy involves the creation of altered states of relaxation for control of pain and other behavioral changes. Patients can be taught to enter an enjoyable, relaxed state and use verbal suggestions and imagery to shift focus from pain, change the nature of the pain experience, improve sleep, mood and self esteem, control dysfunctional habits, visualize future goals and other changes. Hypnosis can be especially useful for reducing the posttraumatic anxiety and sleep disturbance assiociated with life threatening accidents. Patients are given homework in writing hypnotic scripts using verbal and imagery suggestions that match their goals. Both audio and videotape homework is also used to augment skill development. Hypnotic relaxation procedures are often combined with biofeedback for optimum results.
In addition to their individual training, patients in the Inpatient Pain Program attend a series of Stress Management Workshops. This sequence of cognitive-behavioral group psychotherapy sessions focuses on the nature of stress and pain and teach specific management skills that can be used for coping with pain and associated mood and behavioral changes. Information and techniques are presented through structured discussion, in group practice and homework assignments. Cognitive-behavioral strategies for stressor reduction, use of resources, breathing, relaxation, imagery and cognitive restructuring are discussed.
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