Bio Feedback

What is biofeedback?
Biofeedback is a technique in which people are trained to improve their health by learning to control certain internal bodily processes that normally occur involuntarily, such as heart rate, blood pressure, muscle tension, and skin temperature. These activities can be measured with electrodes and displayed on a monitor viewable by both the patient and their health care provider. The monitor provides feedback to the participant about the internal workings of his or her body. This person can then be taught to use this information to gain control over these "involuntary" activities. Biofeedback is an effective therapy for many conditions, but it is primarily used to treat high blood pressure, tension headache, migraine headache, chronic pain, and urinary incontinence.

Are there different types of biofeedback?
The three most commonly used forms of biofeedback therapy are:
* Electromyography (EMG), which measures muscle tension
* Thermal biofeedback, which measures skin temperature
*Neurofeedback or electroencephalography (EEG), which measures brain wave activity

How does biofeedback work?
Scientists are not able to explain exactly how or why biofeedback works. However, there does seem to be at least one common thread: most people who benefit from biofeedback have conditions that are brought on or made worse by stress. For this reason, many scientists believe that relaxation is the key to successful biofeedback therapy. When a body is repeatedly stressed, internal processes like blood pressure become overactive. Guided by a biofeedback therapist, a person can learn to lower his or her blood pressure through relaxation techniques and mental exercises. When a person successfully relaxes and lowers their blood pressure, the feedback signals reflect this accomplishment. This acts as affirmation and encouragement for the person's continued efforts.

What happens during a biofeedback session?
In a normal biofeedback session, electrodes are attached to the skin. These electrodes then feed information to a small monitoring box that translates the physiologic responses into a tone that varies in pitch, a visual meter that varies in brightness, or a computer screen that varies the lines moving across a grid. The biofeedback therapist then leads the person in mental exercises. Through trial and error, people can soon learn to identify and control the mental activities that will bring about the desired physical changes.

What is biofeedback good for?
Various forms of biofeedback appear to be effective for a range of health problems. For example, biofeedback shows considerable promise for the treatment of urinary incontinence, which affects over 15 million Americans. Many people prefer biofeedback over medicine because of the lack of side effects. Based on findings in clinical studies, the Agency for Health Care Policy and Research has recommended biofeedback therapy as a treatment for urinary incontinence. Biofeedback also appears to be helpful for people with fecal incontinence.
Research also suggests that thermal biofeedback may soothe the symptoms of Raynaud's disease (a condition that causes diminished blood flow to fingers, toes, nose or ears) while EMG biofeedback has been shown to reduce pain, morning stiffness, and the number of tender points in people with fibromyalgia. In addition, a review of scientific clinical studies found that biofeedback may help people with insomnia fall asleep.
Biofeedback can also be used effectively for certain ailments in children. For example, EEG neurofeedback (especially when combined with cognitive therapy) has been reported to improve behavior and intelligence scores in children with attention deficit/hyperactivity disorder (ADHD). Biofeedback combined with fiber may also help relieve abdominal pain in children. Thermal biofeedback helps alleviate migraine and chronic tension headaches among children and adolescents as well.

Biofeedback may also be useful for the following health problems:
* Anorexia nervosa
* Anxiety
* Asthma
* Autism
* Back pain
* Bed wetting
* Chronic pain
* Constipation
* Depression
* Diabetes
* Epilepsy and related seizure disorders
* Fecal incontinence
* Head injuries
* High blood pressure
* Learning disabilities
* Motion sickness
* Muscle spasms
* Sexual disorders, including pain with intercourse
* Spinal cord injuries

How many sessions will I need?
Each session generally lasts less than 1 hour. The number of sessions required depends on the condition being treated. Many people begin to see results within 8 - 10 sessions. Treatment of headache, incontinence, and Raynaud's disease (a condition that causes diminished blood flow to the fingers, toes, nose, or ears) requires at least 10 weekly sessions and then less frequent sessions as health improves. Conditions like high blood pressure, however, usually require 20 weekly biofeedback sessions before improvement can be seen. In addition to these sessions, you will also be taught mental exercises and relaxation techniques that can be done at home and must be practiced at least 5 - 10 minutes every day.

Are there any risks associated with biofeedback?
Biofeedback is considered a safe procedure. No negative side effects have been reported

What Happened?

Alcohol primarily interferes with the ability to form new long–term memories, leaving intact previously established long–term memories and the ability to keep new information active in memory for brief periods. As the amount of alcohol consumed increases, so does the magnitude of the memory impairments.
Large amounts of alcohol, particularly if consumed rapidly, can produce partial or complete blackouts, which are periods of memory loss for events that transpired while a person was drinking. Blackouts are much more common among social drinkers—including college drinkers—than was previously assumed, and have been found to encompass events ranging from conversations to intercourse.
Mechanisms underlying alcohol–induced memory impairments include disruption of activity in the hippocampus, a brain region that plays a central role in the formation of new auotbiographical memories. If recreational drugs were tools, alcohol would be a sledgehammer. Few cognitive functions or behaviors escape the impact of alcohol, a fact that has long been recognized in the literature.
As Fleming stated nearly 70 years ago, “the striking and inescapable impression one gets from a review of acute alcoholic intoxication is of the almost infinite diversity of symptoms that may ensue from the action of this single toxic agent”.
In addition to impairing balance, motor coordination, decision making, and a litany of other functions, alcohol produces detectable memory impairments beginning after just one or two drinks. As the dose increases, so does the magnitude of the memory impairments.
Under certain circumstances, alcohol can disrupt or completely block the ability to form memories for events that transpire while a person is intoxicated, a type of impairment known as a blackout. This article reviews what is currently known regarding the specific features of acute alcohol–induced memory dysfunction, particularly alcohol–induced blackouts, and the pharmacological mechanisms underlying them.

EFFECTS OF ALCOHOL ON MEMORY
To evaluate the effects of alcohol, or any other drug, on memory, one must first identify a model of memory formation and storage to use as a reference. One classic, often–cited model, initially proposed by Atkinson and Shiffrin, posits that memory formation and storage take place in several stages, proceeding from sensory memory (which lasts up to a few seconds) to short–term memory (which lasts from seconds to minutes depending upon whether the information is rehearsed) to long–term storage.
This model often is referred to as the modal model of memory, as it captures key elements of several other major models. Indeed, elements of this model still can be seen in virtually all models of memory formation.
In the modal model of memory, when one attends to sensory information, it is transferred from a sensory memory store to short–term memory. The likelihood that information will be transferred from short–term to long–term storage, or be encoded into long–term memory, was once thought to depend primarily on how long the person keeps the information active in short–term memory via rehearsal.
Although rehearsal clearly influences the transfer of information into long–term storage, it is important to note that other factors, such as the depth of processing (the level of true understanding and manipulation of the information), attention, motivation, and arousal also play important roles.
Variability in the use of terms, particularly in operational definitions of short–term memory, makes it difficult to formulate a simple synopsis of the literature on alcohol–induced memory impairments.
As Mello (1973) stated three decades ago with regard to the memory literature in general, “The inconsistent use of descriptive terms has been a recurrent source of confusion in the ‘short–term’ memory literature and ‘short–term’ memory has been variously defined as 5 seconds, 5 minutes, and 30 minutes”.
In spite of this inconsistency, several conclusions can be drawn from research on alcohol–induced memory impairments. One conclusion is that the impact of alcohol on the formation of new long–term “explicit” memories—that is, memories of facts (e.g., names and phone numbers) and events—is far greater than the drug’s impact on the ability to recall previously established memories or to hold new information in short–term memory.
Intoxicated subjects are typically able to repeat new information immediately after its presentation and often can keep it active in short–term storage for up to a few minutes if they are not distracted, though this is not always the case.
Similarly, subjects normally are capable of retrieving information placed in long–term storage prior to acute intoxication. In contrast, alcohol impairs the ability to store information across delays longer than a few seconds if subjects are distracted between the time they are given the new information and the time they are tested.
In a classic study, Parker and colleagues reported that when intoxicated subjects were presented with “paired associates”—for example, the letter “B” paired with the month “January”—they were impaired when asked to recall the items after delays of a minute or more.
However, subjects could recall paired associates that they had learned before becoming intoxicated. More recently, Acheson and colleagues observed that intoxicated subjects could recall items on word lists immediately after the lists were presented but were impaired when asked to recall the items 20 minutes later.

Normal Collides W The Program

As not only an Addiction Medicine Physician, but also a recovering person myself, this is a topic I often like to bring up with patients early in the recovery process. I can honestly say that if being sober wasn’t a heck of a lot of fun, I couldn’t do it!
Today, I can unequivocally say that my recovery is the best thing that ever happened to me! I certainly wasn’t able to say that in a detox center, but today I know it’s true. Why? Because in Recovery I found what I was always looking for, and that is, to feel good!
Early in my using, alcohol and other drugs did indeed make me feel very good. Like many other individuals with Chemical Dependence,
I recall that the first time I drank was the first time I felt “normal,” better than that, I felt great! Think about it, if once upon a time, alcohol or other drugs didn’t do something extremely powerful for every patient with an addiction, they wouldn’t be willing to risk their families, freedom, jobs, liver and lives to keep doing it. The substances stop working, but we keep using them. That’s addiction.
As the problems and crises mounted up, many of us “quit.” But that doesn’t work, because abstinence is not recovery. In fact, when all I did was “quit,” I thought that was worse than using, because I had nothing to “numb” that horrible feeling that seemed to follow me everywhere I went.
But when I engaged myself in that nebulous thing they called recovery (support groups, sponsors, aftercare, etc.,) then I got the payback! For the first time in my life, without alcohol or other drugs,
I felt exactly the way I always wanted to feel. Then, recovery becomes easier. Why would I not do this? This is the greatest thing that’s every happened to me!
The tricky part is getting from “A” when there are problems or crisis, to “B” when many of us say “I really like this.” It’s tricky because most of us have to engage in the recovery process without reservation before we reap the benefits. But what benefits there are!
Several years ago, I was reading a newsmagazine about “The Science of Happiness.” Why are some people happier than others? While scientists are still studying this dilemma, they listed 10 things that appear to be common in people who are very happy. Most of the items were right out of the support systems many Chemically Dependent individuals follow in order to keep sober!
These included close groups of friends that we meet with on a regular basis, a sense of humor, a concept of some Higher Power, and helping others. I’m sure these concepts sound very familiar to many who are engaged in some of the Self-Help Groups.
My dearest friends in the world are my fellow addicts and alcoholics. These people listen to me and love me, with no ulterior motive, and try to help me (whether I want it or not,) warts and all. In addition, these same people are relying on me to try to help them. It seems to me that when you have a few people in your life like that, it’s pretty easy to stay sober!
My recovering friends and I like to do fun things a few times a year. We have taken to calling it the “Men’s Weekend” because “Retreat” would be too strong of a word! It might be houseboats in Tennessee, a camp in the Thumb or cottages up North. We eat, fish, golf, sit around a campfire, go to local support meetings, everything but drink and drug, and do we ever have fun!
For several years, we used to say that the events were open to “men in recovery.” Then, several years ago, something unusual happened.
My brother-in-law, a non-alcoholic, was asking about one of our outings he heard me discussing and asked if you had to be an alcoholic to attend. I was somewhat taken aback and said I didn’t know for sure, but asked him why he would want to attend.
I’ll never forget his response. He told me he had over the years met many of my recovering friends and enjoyed their company immensely, and in fact, said some of the most fun times he had were when he was doing things with them!
When someone who isn’t alcoholic or drug addicted looks at what I’m doing to save my life, and says, “That looks like fun, can I come too?” I’m pretty certain I’m doing the right thing! We now refer to the Men’s Weekend as being open to men in recovery, or men who enjoy the company of men in recovery.

So you see: Recovery can indeed be rewarding and fun. And to think this alcoholic/addict “accidently” backed his way into it, because nothing else was working in my life. Why, you’d think there might have been some Higher Power overseeing it all along!

Mark Menestrina, MD, FASAM
Medical Director, Detox Unit, Brighton Hospital