Biofeedback: A Case Study - car trauma

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In a previous blog I indicated the process in a typical Biofeedback training session. I'd like to share a case study where a patient who was involved in a car accident was referred by her GP and was seeking treatment for anxiety and depression.

The patient had been a passenger in the rear seat of a friends car when another car traveling at speed ran into the back of my patients car. Although the patient no longer had any physical concerns, her life was being dramatically restricted due to the fact that she no longer could get into a car. She was in jeopardy of losing her job as the daily commute by public transport (1 1/2 hrs each way) was taking its toll on her. She arrived at work tired, unable to give her work her full attention and as she no longer drove, involvement in activities that brought fun and meaning to her life had decreased. She had started to become socially isolated.

The treatment for her anxiety consisted of initial sessions with Biofeedback. In the first session a history of her current functioning (sleep, appetite, diet, exercise, social activities, interpersonal relationships any decline in hygiene or personal care, etc) was explored versus her going over the event that took place when she was in the car accident. If she wanted to talk about the car accident this was not discouraged, however it is my preference that patients spend only a small amount of time discussing the triggering event of their anxiety. I assume that the individuals coping skills have been compromised by the triggering event (why else would they be seeing me?) and my goal is not to have the patient leave my office feeling worse than when they came in. By processing the event with the patient when their coping skills for that event have been obviously overwhelmed this activity is likely to reinforce the anxiety. Further, most, if not all my patients are relieved to hear that they do not have to visit the triggering event ont he first session.

Once the current functioning has been explored my patient was educated utilising a video on how anxiety works in the mind and body. This understanding of how the mind and body interact is essential in understanding the Biofeedback training process. She was then introduced to the Biofeedback system and shown how the system responds to negative thoughts.  After the first session she was invited to purchase a meditation audio CD (I provide a list of the ones that I have had the greatest success with) and instructed on the use and frequency of the meditation CD.

The second session focused entirely on the Biofeedback training. My patient was instructed to visit her memory of the meditation CD while connected to the Biofeedback system to see if she had made any improvement based on listening to the CD. Through the use of headphones, she listened to the CD while still connected to the Biofeedback system. The 2 profiles were then compared. 90% of the time there is a stronger modulation with the CD than with the patient alone.  When she could see this result, she could feel confident that the CD was useful and all she needed to do was practice.

Through the use of the Biofeedback training she started to develop strong coping skills. Because she could see these skills developing on the computer monitor she started to build confidence in her ability to modulate her anxiety. To further improve her emerging skills she was introduce to the Heartmath system (the use of breath to regulate anxiety) and underwent training for a couple of sessions with this device. Her confidence in her emerging regulatory skills is crucial to addressing triggering events (car accident). The fact that the skills are measurable is also very important.

It was at this stage that processing of the event took place. This was done while she was connected to the Biofeedback system. When the system indicated that she was getting anxious the processing of the event was discontinued and she was directed to lower her anxiety using the skills that she had mastered during the training. As she saw her anxiety decreasing to a low level, processing of the event continued.

Once the patient had processed the event in its entirety (approximately 2 to 3 times) without any significant increase in arousal on the Biofeedback system, we went to the next level.  A friend was asked to drive with her to the next session. Through systematic desensitization my patient was directed to sit in the car behind the drivers seat. She was wearing one of the devices that I provide to my patients (in this case it was the Spire device that monitors breathing patterns and begins to vibrate if the persons breathing becomes shallow) to give her an early warning that she is getting anxious. Physiological reactions usually take place before an individual has an awareness of their anxiety. After sitting for a few minutes she was invited to start the engine. When there was no objective indication of anxiety (the Spire device did not vibrate) and no significant subjective feelings of anxiety, she was invited to drive around the block with her friend in the front seat.  This she did successfully. She was then invited to sit in the rear seat and again the same process was undertaken. She successfully sat in the back seat as the car was driven by her friend around the block. This had been the first time that she had been in a car for over 6 months since the accident. She drove home and therapy was discontinued with the understanding that she would come back in a month as a followup session. She had had a total of 5 sessions. At followup, she was back to driving normally (with some minor hyper vigilance) and had regained her life.