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Irritable Bowel Syndrome and Other Gastrointestinal Disorders
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Assessment of condition
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Overview
If you have already been diagnosed with Irritable Bowel Syndrome, your family doctor or GI (gastrointestinal) specialist (gastroenterologist) may have already prescribed medication, provided you guidance regarding your diet, and scheduled some tests for you. If you have followed your doctor's recommendations carefully, yet your IBS still has the tendency to "flare up," you may wish to examine the psychological, social, and behavioral issues that appear to worsen your GI problems.
The approach used in biofeedback is more generalized than specific. This means that your biofeedback therapist will be interested in helping you achieve overall, generalized relaxation. Although skeletal muscle relaxation --- referring to the muscles of your head, neck, arms, legs, etc. --- may be facilitated via EMG biofeedback, the eventual goal would be to help you exert some voluntary changes in the smooth muscle of your gastrointestinal (digestive) system. These skeletal and smooth muscle changes can help you decrease hypermotility or hypomotility of your disgestive system.
Some of the same principles that effectively address panic and anxiety treatment would be applicable with IBS and other GI disorders. Decreasing autonomic arousal or sympathetic activation would be an important achievement. What happens when the autonomic nervous system or sympathetic nervous system becomes activated? Your skin surface temperature will likely decrease because of a vasoconstriction (meaning your blood vessels --- veins, arteries, capillaries --- start to get smaller in diameter). Cold hands and cold feet are a good example of this stress response known as autonomic arousal. Your heart rate may also increase above your normal baseline. Your blood pressuress will likely become elevated. You may experience some sweat gland activity, particularly in your hands, feet, and axilliary region ("armpits"). And your "gut" --- your digestive system, stomach, intestines, etc. --- will be adversely affected. So-called "stomach cramps," excessive bloating, flatulence ("gas"), diarrhea, and other GI issues can also emerge with such autonomic arousal. In order for you to be successful in diminishing your IBS, you may need to address all of these issues.
Sensors
To educate you about the interaction of your thoughts, behaviors, and physical changes, a multimodal biofeedback approach would be used. EMG, skin surface temperature, heart rate variability, and SCL (skin conductance level or sweat gland activity) sensors would be utilized for this comprehensive training.
Where sensors are placed
EMG sensors would be placed on the forehead. The skin surface temperature sensor would be placed on your index finger. The heart rate variability sensor (photoplethysmograph) would be placed on your thumb or index finger. The skin conductance level sensors would be placed on your third and fourth fingers.
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Behavioral intervention
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Learning and behavioral change
The concept of psychosomatic conditions is based on the notion that the psych (Greek for "mind") part of you influences the soma (Greek for "body"). The applied psychophysiological and biofeedback approach to IBS makes the assumption that your gastrointestinal problems may be influenced by certain stressors --- whether obvious environmental problems like a demanding work schedule or more subtle, internal, possibly "unconscious" concerns like constant fear, worry, or guilt. Whether overt and obvious or unconscious and insidious, these psychological issues can nonetheless affect you physically. If you happen to be one of those people who typically think, "I'm so upset that it feels like my stomach is tied up in knots," your GI problems may have a psychological or behavioral component.
Of course, it is important to verify with your family doctor, internist, or gastroenterologist that there is no acute medical problem that require immediate or ongoing attention. However, if your family doctor or specialist has completed all of the appropriate medical "work-ups" and no serious medical problem has been identified, then you would do well to confer with him or her about the idea of receiving stress management, relaxation training, or biofeedback to lower your excessive physiological arousal.
Biofeedback seeks to lower your sympathetic activation or autonomic arousal. You may think of this activation or arousal as being similar to a car engine that is idling at twice the speed that is necessary to keep the engine running! The engine is burning up a tremendous amount of fuel, possibly causing the engine to overheat, potentially causing damage to the engine, and yet the car is "going nowhere fast!" If you lower the idling speed to a more reasonable "RPM," then the engine continues to run, does not use excessive energy, is relatively safe from damage, and when placed "in gear," the car moves forward in a gentle but "surefooted" manner. Biofeedback attempts to teach you how to operate at a reasonable "idling speed" while simultaneously training you to respond to the demands of the environment, no matter what that environment may be --- work, home, school, community, and so on.
A variety of different biofeedback techniques and modalities may be used to help you achieve this normal, reasonable "idling" speed. Heart rate variability training and diaphragmatic breathing are relatively easily learned techniques, and they would be first skills for you to learn. You would be taught to coordinate the activity of your heart and lungs --- something called coherence --- with this type of training. Skin temperature (thermal) biofeedback would be taught so that you would learn to increase circulation in your fingertips and toes, a technique that is known to decrease autonomic arousal. Your muscle tension would be assessed with EMG sensors. In addition, one or more sessions may be devoted to the monitoring and training of sweat gland activity, primarily for the purpose of demonstrating how your thoughts can either lower or raise your panic and anxiety. Brain wave biofeedback (neurofeedback) may be used to demonstrate how intrusive thoughts, rumination, and "worry" are reflected in High Beta wave activity. Alpha-Theta neurofeedback training may be used to train you into deep relaxation states --- a feeling of physical and psychological "peace" that you may not have experienced for many years!The principal
Number of sessions
The number of sessions is totally dependent upon your particular issues, and the severity and duration of you gastrointestinal problems.
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Change in behavior
Goals
Improvement in a variety of areas is expected. This would include less gastric distress, more "normal" digestive habits, less concern about needing to follow an extremely limited diet, more freedom to pursue personal and professional activities without fear of gastrointential problems.
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