Medical data. This client was a 38-year-old sheet metal worker who was married with three grown children. He came to BRI hoping to learn ways of managing pain and stress.
In the medical history section of the intake, the client reported that his father suffered from diabetes and alcoholism, his mother had allergies, and his brother had arthritis as a result of a knee injury. He stated that when working he consumed an average of a quart of coffee a day, that he drank alcohol occasionally, that he smoked more than a pack of cigarettes a day, and that he took Vicodin and Tegretol for pain and seizures.
The client had been hospitalized once for appendicitis and once for fractures of the right tibia, right fibula, and left tibia, compression fractures, concussion, and lacerations.
When asked what non-prescription medicines he used, the client listed aspirin, taken for headaches once or twice a month, and antacids taken for heartburn once or twice a month. He stated that he caught a cold once a year.
During the past year, the client reported that a brain map and X-rays of both legs have been taken, and that he had received physical therapy and chiropractic treatments. When asked if he had ever had a traumatic or consciousness-altering experience such as accident, use of anesthesia, etc., he stated that he had had a concussion and received anesthesia and morphine.
When asked what forms of medical, psychological, spiritual teaching/therapy he had undergone in the past 2 years, the client stated that he had received counseling for 3 months, that he saw an orthopedist every 4 months, and that he had seen a neurologist twice. He did not respond to the question, "What are your current health concerns?"
In the lifestyle portion of the intake, the client stated that 50% to 60% of his life was scheduled, 40% to 50% unscheduled, and that this balance suited him. When asked if he could do one thing at a time and really focus all his attention on it, and if not, why, he replied that he could usually, but that when he couldn't he experienced "loss of mental acuity, clarity." He said that he could usually leave his work at work, and that he read every day as a way of releasing tension from work.
When asked if it were important for him to have time by himself, he answered yes, but when asked if it were easy to take what he needed he answered "yes/no" because there was "not enough time-too much noise, distraction." He stated that his work detracted from his home life because of "too much stress."
The client said that his most important relationship was with his wife, whom he had known for more than 16 years, and that the relationship was becoming more distant due to "too much stress and strain during the last 2 1/2 years." The client lived with his wife, their daughter, and their grandson.
The client stated that it was not easy for him to express his feelings, particularly irritation and anger with his family. He said that it was "not always" easy for him to express his love, and that sometimes when he tried he would "stumble over [his] own feet." He said that it was not easy for him to ask for help and that doing so made him feel inadequate, and said that he was more self-critical than self-accepting. He said that it was not easy for him to know what he wanted and to ask for it because he was "sometimes unsure of wants, sometimes [he didn't] know how to go about asking." He stated that he was experiencing "moderate to high" emotional stress/problems in his life. When asked what hobbies he enjoyed, he listed "reading" and "fire fighting," and stated that the time he was able to give himself for these activities varied each week. He responded with a question mark to the questions, "What do you do to reward yourself?" "What do you do for fun?" and "List three things under $2.00 that make you feel good." He did not respond at all when asked, "What new learnings or personal growth experiences have you undertaken in the past year?"
During the first 5 minutes of the initial evaluation, eyes closed, nontalking, this client's temperature rose from initial readings of approximately 94.5 degrees (left hand) and approximately 92.3 degrees (right hand) to approximately 96.2 and 95.8, respectively, and remained at this level during the next 5 minutes, eyes open, nontalking. At the beginning of the 15-minute, eyes open, talking baseline, Temps dropped to an average of approximately 94 degrees before rising slightly toward the end of the baseline. During the final, 7-minute, eyes closed, self-soothing baseline, Temps rose to approximately 97 degrees and 95.8 degrees, respectively.
Initial right trapezius EMG readings for A. A. during the first 5 minutes rose from 18 microvolts to approximately 21.5 before dropping slightly to approximately 21 microvolts. During the second 5 minutes, scalp EMG continued to drop and leveled out at approximately 16.1 microvolts. At the beginning of the 15-minute, talking baseline, right trapezius EMG activity rose dramatically, then dropped before rising again and eventually reaching more than 40 microvolts. Readings remained more or less elevated until the beginning of the 7-minute self-soothing baseline, when they dropped quickly to a low of 6 microvolts. Left trapezius muscle EMG readings remained low during the first and second 5-minute baselines, rising from approximately 4 microvolts to an average of approximately 8.5 microvolts during the 15-minute talking baseline, then dropping back down to a low of approximately 3 microvolts.
Skin conductance level during the first two 5-minute baselines increased steadily from an initial reading of approximately 4.9 micromhos to approximately 3.3 micromhos. During the 15-minute, talking baseline, SCL rose to approximately 6.1 micromhos, and continued to rise during the first 2 minutes of the self-soothing baseline before dropping to approximately 5.2 micromhos at the end of the session.
Phasic skin response (GMAX) remained low (between 0 and 20 units) during the first two baselines, then rose quickly to approximately 230 units at the beginning of the 15-minute talking baseline. Readings then dropped somewhat and remained approximately in the 60-150 unit range for the remainder of the baseline. After an initial rise from approximately 70 to approximately 150 units at the beginning of the 7-minute self-soothing response, readings declined to an average of approximately -10 units,
A. A.'s heart rate during the initial 5-minute, eyes closed, nontalking baseline rose from 73 to approximately 76.5 beats per minute, then dropped to 74 beats per minute. During the second 5-minute, eyes open, nontalking baseline, heartbeat averaged approximately 74 beats per minute. At the beginning of the 15-minute, eyes open, talking baseline, heart rate increased sharply to approximately 82.5 beats per minute, and fluctuated between a high of approximately 83.5 and a low of approximately 77 beats per minute for the remainder of the baseline. Heart rate dropped at the beginning of the 7-minute self-soothing response baseline to 72 beats per minute, and followed a lowering pattern to a low of approximately 69 beats per minute before rising to approximately 73.5 beats per minute at the end of the session.
The initial levels brainwave levels in the alpha bandwidth dropped from an average of approximately 270 microvolts per second to an average of approximately 160 microvolts per second during the first 5-minute baseline. Activity in the theta, beta and gamma bandwidths increased slightly during this time. During the second 5-minute baseline, activity in all bandwidths remained more or less constant, rising slightly at the end of the baseline (except for alpha, which dropped slightly). During the 15-minute, eyes open, talking baseline, activity in the beta and gamma bandwidths increased to an average of approximately 175 and 75 microvolts per second, respectively, and rose and fell in approximately the same pattern. Alpha activity during this time rose somewhat, maintaining an approximate average of 160 microvolts per second. The pattern displayed in the alpha bandwidth during this segment was also roughly mirrored by theta activity, which averaged approximately 120 microvolts per second. During the 7-minute self-soothing baseline, alpha activity again rose to an average of approximately 270 microvolts per second before dropping to an average of approximately 190 microvolts. Activity in the theta, beta and gamma ranges dropped at the beginning of this baseline, reaching levels slightly lower than their initial readings.
Throughout the session, beta activity was biased primarily to the left hemisphere, while alpha, theta and gamma activity was somewhat more balanced.
This chart (charts will be coming to this web site at a later date) represents similar information to that displayed in the EEG chart, the difference being that it is shown in a three-dimensional format. The brain maps provide a more complete sense of bandwidth activity due to greater frequency resolution. The two-dimensional EEG chart represents 256 data points; in contrast, the three-dimensional chart shows 1344 data points. When viewing these three-dimensional EEG displays, one will immediately notice color shading. Each color corresponds to magnitude of activity: white represents the lowest level, green the next level, magenta next, and blue the highest level. Colors do not represent any particular bandwidth, but indicate the magnitude of activity. This color shading strategy is utilized in all three-dimensional brain maps throughout this study.
A. A. presented with recurrent headaches and outbursts of frustration and anger, indicating that the appropriate modalities for training would be EMG, EEG, EDA, Respiration and Temp. During his initial evaluation, A. A. showed elevated levels of activity and gross imbalance in shoulder EMG readings. Clinically significant levels of activation also appeared in A. A.'s electrodermal responses.
During the initial training sessions, A. A. exhibited the greatest capacity for self-regulation in EMG and Temp. He was able to make contact with these systems within a couple of sessions, and we focused on reducing and balancing right and left shoulder EMG activity.
A. A. was a sheet metal worker, and as such he was able to relate to biofeedback training in terms of the mechanics involved. I facilitated this by describing the mechanical nature of the training, explaining the biomechanical nature of the musculo-skeletal system and how EMG activity reflects mechanical habits. From the fifth session on, we spent substantial amounts of time discussing how A. A. could integrate his training into daily life. As he gained increased control over EMG, we began shifting our focus to BSR and Respiration. I anticipated that EDA training would be somewhat more difficult, so I did not actively introduce it until the sixth session, after A. A. had achieved appreciable success in EMG.
Training in respiration was a natural next step, since we were working with the shoulders in EMG training, and placement of sensors in this modality allows a respiration visual feedback loop that can be seen on the computer screen. As the client inhales, an EMG deflection is registered by a line graph traveling across the screen. Breaths per minute may be observed by the number of rises and falls per minute. Maximum relaxation of the shoulders may be seen at the bottom of the fall, which generally occurs at the exhale, and the amount of upper thoracic involvement is indicated by the magnitude as measured in microvolts between the bottom and the top of the wave.
By the eighth session, I began to introduce EEG as part of each training session; although we knew that we would have a limited number of training sessions, I believed A. A. would benefit from some EEG training.
By the twelfth session, A. A. had demonstrated initial control over both channels of EMG, both channels of Temp, Respiration, and some EEG.
As A. A. began to understand the relationship of his anger responses to his headaches vis-a-vis his biofeedback training, we began to notice a reduction in frequency and intensity of headaches. By the twelfth session, A. A.'s headaches had become infrequent and significantly less intense, and he reported having developed an understanding of how his actions impacted his physiology.
After 12 sessions, A. A.'s temperature readings showed an average of approximately 97 degrees, very close to core body temperature, with the right hand achieving 98 degrees during this session. Although hand temperature was not a primary issue in training, the client nevertheless enhanced the relaxation response in peripheral blood flow.
By the twelfth session, one can see by the chart that two variables had changed remarkably. Not only did the right shoulder EMG activity show a dramatic reduction from gross overactivation to a very relaxed state, but left shoulder EMG activity diminished from moderate overactivity to the same relaxed state, achieving both peak performance homeostasis and bilateral symmetry.
A. A.'s skin conductance level was quite elevated initially, with the phasic component moderately active. By the twelfth session, A. A. had begun to develop the capability to facilitate a substantial quieting response in this modality. Note that although he began the session at an active level, he was able to steadily quiet it down during the session.
Heart rate was not measured during this session.
Although we did not spend much time working in this modality due to training priorities in other modalities and the limited number of sessions, we did see a general reduction in beta and gamma activity, and a modest increase in alpha activity. Further, A. A. developed an initial awareness of what provoked higher beta activity and was able to make some practical changes to moderate that behavior.
As can be seen from the chart on page 126, some progress was made in achieving balance between right and left hemisphere activity, particularly in the beta and gamma frequencies.
When looking at this chart, it is useful to note the relatively even, peaceful look of the EEG data represented and the general bias towards alpha activity. The three-dimensional charts included in the pre- and post-training series presented here are useful because they provide an overview of electroencephalographic activity during a session in three axes. The interpretation of these charts is similar to that of the EEG line graphs, but the information display provides a more complete view of overall activity, giving a "feel" for the client's consciousness state.