Biofeedback ⎪ Summer 2005 51 children have more confidence in special abilities,children have and more psychophysiologic ability. children have children are more enthusiastic, procedures, children are less skeptical about self-control Attansio and Andrasik (1985) list the following rea- Andrasik (1985) list the following Attansio and Table 1.Table Self-regulation (cyberphysiologic) techniques in pediatrics Biofeedback Self-hypnosis (mental imagery) Progressive muscle relaxation Autogenics breathing Diaphragmatic Yoga Positive self-talk Meditation and older are the ideal candidates for self-regulation and older are the training. are better than sons as to why they believe children adults at self-regulation • • • • Many Doors to the Same Room? thought that many self-regulation strate- long have We in fact result may gies share common characteristics and in a similar end-state of mind/body balance. In addition, we believe that many, if not all, of the strategies listed altered state of below lead the child patient into an that is similar,awareness if not identical, to the state induced in hypnotic trance. This suggests that therapists and be aware working with children and teens must to the language respectful of this fact and be attentive in these altered used when working with children/teens states (see Kohen and Reaney, 1998). Our experience with children and teens indicates that a useful approach is to be flexible in offering patients a variety of self- management/relaxation options and then to allow them cyber which means to kyber,

The authors have observed intermittent skepticism observed have The authors steer or to take the helm. Biofeedback and hypnosis are (or applied psy- excellent examples of cyberphysiologic come of age in pedi- chophysiologic) strategies that have atrics,“on the fringe” or even moving from alternative well accepted by medicine in the late 1970s to being quite most pediatric clinicians today. In a 1998 survey of pedia- tricians in Michigan, and Laken (1998) found that Sikand for a comple- over 50% stated they would refer a child listed as most mentary therapy with biofeedback being acceptable. this area to whom we all owe in Early pioneers thanks include Karen Olness, Kohen, Daniel Wayne Rusin,Wikramasekera, Ian Daniel Brown, and others. about the appropriateness of utilizing self-regulation techniques, such as hypnosis and biofeedback, with children and teens. the evidence indicates that chil- Yet dren are more talented than adults in practicing self- regulation techniques. that Studies consistently show children as a group are highly hypnotically susceptible, making them excellent candidates for self-hypnosis training. consistently shown studies have Biofeedback that children are quite adept at physiologic control and that with certain modalities, such as peripheral temper- ature, children are in fact better than adults. Child development theory would suggest that children ages 7 Introduction back in the 1980s The term cyberphysiology was coined by Karen Olness, MD, therapeutic to denote and others techniques that facilitate self-regulation.word The is derived from the Greek word This article reviews the literature on the interface of the literature on the interface article reviews This specific to pediatrics.biofeedback and hypnosis Two usage are discussed:paradigms of common biofeed- biofeed- back-assisted hypnosis and hypnosis-assisted back. rationale for integrating these self-regulation The and teens (cyberphysiologic) techniques with children disorders is also with a variety of psychophysiologic discussed. Timothy P. Culbert, MD, Richtsmeier Cyr, Lynda PhD, and Maura Fitzgerald, RN, Medicine Program,Integrative CNS Hospitals and Clinics, Children’s Minneapolis, MN Keywords: hypnosis, biofeedback, self-regulation, pediatrics, applied psychophysiology Hypnosis, Biofeedback, Self-Regulation and “Cyberphysiologic” in Pediatrics: Approaches SPECIAL TOPICS SPECIAL 52 Summer 2005 ⎪ Biofeedback Cyberphysiologic Pediatric Approaches can resultindirectedtherapeuticchange(Table 2). balanced stateofmindandbody(thesameroom)that mostindividuals endupinadesirable, (many doors), Biofeedback canbeusedtofacilitate thehypnosisexpe- Biofeedback-Assisted Hypnosis common usage. between biofeedbackandhypnosis andtwoparadigmsof In thissectionwewillreviewthespecificrelationship Biofeedback/Hypnosis Interface • • • • • • • • • • these self-regulationtechniquesshareinclude shown in Table 1. techniques commonlyusedwithchildren/teensare Some examplesofcyberphysiologicorself-regulation ship andcontrolimprovespracticecompliance. We have foundthatthisenhancesthesense ofowner- to chooseatechniqueortwothattheyenjoythemost. Vocal corddysfunction Asthma Headaches Sleep disorders Neuromuscular disorders Enuresis Stress management Chronic/recurrent pain or adjuncttherapy Conditionsandsymptomsinpediatricsforwhichcyberphysiologicstrategiesareappropriateasprimary Table 2. Regardless ofwhattechniqueoneusestogetthere Some ofthecommoncharacteristicsthatmany heightened suggestibility. and enhanced accesstosubconsciousmaterial, tional mind/bodyeffects, reinforcement andincreasedawareness ofbidirec- metaphorically, fostering themesofself-masterybothconcretelyand control, development ofasenseinternalhealthlocus facilitation ofthechild’s imagery/fantasyabilities, facilitation ofthechild’s senseofcuriosity, heightened awareness ofinternalevents andsensations, enhanced andnarrowedfocusofattention, system arousal, cultivation ofaloweredstatesympatheticnervous Learning andattentionproblems Recurrent abdominalpain Habit disorders ANS dysregulation Encopresis Anxiety disorders Acute procedural pain o r ed,youcanjust...”) inguidingchildren/teens you areready, Useofpermissive language(“when works bestforthem. pettingadog)toseewhat sitting quietlyinaforest, ing tomusic)andpassiveimagery (lyingonthebeach, danc- playing withfriends, with activeimagery(sports, We have alsoobservedthatkidsmustexperiment etc.). increasedHRV coherence, [HR] andsweatglandactivity, decreasedheartrate (increased peripheraltemperature, results indesirablephysiologicchangepatterns imagery associatedwithpositiveemotionalexperiences We have consistentlyfoundthat biochemical levels. physiologic responsepatternsatneurophysiologicand negative)resultindistinct emotional states(positivevs. active)andassociated that mentalimagery(passivevs. Clearevidencesuggests accelerating physiologicchange. Hypnosis (mentalimagery)canbeapowerfultoolin Hypnosis-Assisted Biofeedback tially useful. Heart ratevariabilitybiofeedback(HRV) isalsopoten- surface electromyography(SEMG)forthispurpose. and peripheraltemperature, dermal biofeedback(EDR), Theauthors have usedelectro- sify thehypnoticstate. whereastheauditorysignalcanbeusedtointen- nosis, es asoothingorcalmingscreenuseseyes-closedhyp- Thechildwatch- at cultivatingloweredstatesofarousal. biofeedbackisexcellent For deepening, tion phenomena. twokeyinduc- awareness ofinternalevents/sensations, opment ofnarrowed/focusedattentionandincreased andconsistentfacilitatethedevel- engaging, rhythmic, Audioandvisualstimulithatare tion toolforchildren. Biofeedbackisaveryusefulinduc- then tore-alerting. and therapeutic suggestionand/orfurtherdeepening, to organized sequencefrominductionanddeepening, that thehypnosisexperiencecommonlyproceedsinan itisimportanttonote First ofall, rience inafewways. Biofeedback ⎪ Summer 2005 53 Culbert, Cyr, Richtsmeier and Fitzgerald Maura Fitzgerald . Biofeedback, Clinical Biofeedback Cyr Lynda Richtsmeier Lynda 1059–1064. 134–141. . Archives of Pediatric and Adolescent and Archives of Pediatric Culbert Timothy (3), 33–35 lizing biofeedback with children. with and attitudes toward complementary/alternative medicine. Medicine, 152, and Health, 8, com- Developmental considerations and therapeutic munication in pediatric biofeedback 26 Correspondence: Timothy P. Culbert, MD, Medicine Program, Hospitals and Clinics MS 17-306, Integrative Children’s Minneapolis, MN 55404, email: [email protected]. References Attansio, V.,Andrasik, & F. (1985). in uti- Clinical issues Sikand, A., & Laken, M. (1998). experience Pediatricians’ Kohen, D., & Reaney, J. (1998). the child: Reaching Cyberphysiologic (self-regulation) strategies are effi- Cyberphysiologic techniques in pediatrics and cient and cost-effective a variety of psy- should be utilized for children with chophysiologic disorders. are very good at self- Children regulation. in non- are increasingly interested Parents and hypno- pharmacological options such as biofeedback conditions.sis for children/teens with a variety of There in biofeedback, is a need for more professional training hypnosis, specific to pediatric and related techniques applications. Summary is essential and preferred to directive language (“I want directive language and preferred to is essential about this...”),you to think ego dystonic which can be for children/teens.and disruptive Additionally, children very specific and unique images;and teens often create it provider to offer suggestions that is important for the “get in the way” but do not are open and inviting of those images. using open-ended suggestions suggest We the time of day,”“notice such as rather than assuming that it is daytime.