Conversion d/o and peripherial Biofeedback
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Transcript of Conversion d/o and peripherial Biofeedback
A Case study (2006)
Conversion DisorderPeripheral Biofeedback
Elizabeth L. Stroebel, PhD
Neurodevelopment CenterProvidence, RI
My “biofeedback prescription” for this case
Professional adaptability and collegiality Histoires de Nez (Kruss) 1989
Reference and Definition Boundaries
Conversion DisorderREFERENCE Etiology, pathogenesis, phenomenology and management continue to arouse debate. Isaac, M. (2006)
Current Opinions in Psychiatry, 19, 61-66.• Hysteria• Malingering (less common)- Feigned-Factitious disorders• Somatoform disorder• Conversion disorder• Psychogenic nonepileptic, pseudo seizures, conversion seizures• Dissociative disorder
STATISTICSIn strictly defined CD-estimated one in 5,000 per years. 2/3 women, appears any age
usually between adol and 40. Note 1%-3% mild CD patients referred to mental health clinics.
DEBATEDSM-IV ICD-10 classification unsuitable across cultures-call for reviews
GENERAL DEFINITION Psychological factors and autonomic activity-symptoms create appearance of medical illness that has not clear medical explanation (Harvard Mental Health Letter. Vol 22. Number 2, 2005)
Unexplained dramatic physical symptoms
• Nausea, vomiting, abdominal pain, dizziness • Pallor and peripheral temperature• Violent tremors, frequent eye rolls• Non-seizures• Blindness (black contact patch) Eye rolls• Reading difficulty, inability to write• Paralysis (waist to fee)• Involuntary sustained contractions of opposing muscles
causing twisted movements or abnormal fixed postures • Dysponesis (clenched and weakened fingers/hands).
Reported total “bodily pain” • Heightened anxiety• Shallow rapid breathing, racing heart sensation, loud voice
Brief patient history• Hospital Admission
• Background
• Profile (patient)
• Onset
• Previous medical and psychological care
Treatment PlanIn-patient
*Complete medical evaluation unremarkable
• In-patient hospital
• Psychiatrist• Peripheral Biofeedback• Hypnotherapy
• Behavioral modification• Group• Recreation
Peripheral Biofeedback: An integrative approach
Modalities HRV---HeartMath/Freeze-Frame
GSR---Galvanic skin conductance
Home trainers/audio tapes
Quieting Reflex (Stroebel)
Autogenic Training
Progressive Relaxation
Guided imagery and visualization
“….it is not the muscles which refuse to obey the will, but the will itself which has ceased to work.” Brodie(1837)
Static electricity generated by
fear, anxiety, anger consumed her….
Osmosis of BeingShe whispered……….
“Look at me”“What am I?”“Who am I?”“I am a non-being”“I feel non-existent”
Heidegger
The plight of the dehumanized. Of connection of that which is real and that
which is possible.
OsmosisA process of absorption or diffusion from
higher concentration to lower vulnerability.
Usually effortless often unconscious assimilation with intermingling of kinetic energy of molecules.
“It is the dead bird in the heart that kills.” Laurence Ferlinghetti Coney Island of the Mind
Placebo Hidden Present Powerful
The power of the individual’s complexity is a covert force linked to the placebo. Seems inaccessible to direct observation yet surfaces as empirical phenomena. (C.F. Stroebel, MD)
Lessons from Biofeedback….
“Still waters run deep” propelled down the pathways of the nervous system to fuel symbolic construction, imagery, emotion, thought, and reactivity, wellness or illness” E. stroebel
“I’m not sure I can get better?” EMPATHY
Histoires de Nez (Kruss) 1989
Biofeedback loopSelf Regulation-Inner core of strength
• Emotional strength
• Empowerment
• Participation
• Not just hope but actualization and restoration
“Talking heads, hearts, and bodies”
Electrodermal (EDR) biofeedback in treating psychogenic nonepileptic seizure Pop-Jordanova et al. University of Skopje, Macedonia. Prilozi:
2005;26(2):43-51.
Discriminative and validation for levels of distress
Good therapeutic results for enhancing patients awareness of choice/power to self-regulate
Interrupting dysponetic patterns/reactivity
Stabilization of hypersensitivity, lower neurotic tendencies. “emotional maturation”
Initial behavioral plan
Softening stress related physical and emotional pain
HeartMath Freeze-Frame Heart rate variability
DISCHARGE“Yeah me!!!! Yeah Me!!!!!!
I’M IN THE GREEN”