Pediatric Annals

Cyberphysiologic Strategies in Pediatric Practice (Biofeedback, Self-Hypnosis, and Relaxation Training)

Karen Olness, MD

Abstract

An important task of child health professionals is to facilitate a sense of mastery and competency in the children they see and to encourage children to take responsibility for health and related behaviors. Learning to use Cyberphysiologic strategies appropriately increases the ability of child health professionals to do this. Applications may range from helping the child to cope with his or her anxiety over a minor procedure to controlling habit problems, to reducing performance anxiety, or to controlling chronic pain. Child health professionals may also personally benefit from learning and practicing specific relaxation methods.

The term cyberphysiology derives from the Greek word kybeman, meaning to steer or take the helm. The concept of helping children steer or take the helm with respect to problems related to pain, habits, or performance is central to the discussions in this issue. The articles that follow provide not only general information regarding types of applications, but also specific examples of some strategies the reader might begin using immediately. Each of the guest authors is an active clinician. The three pediatricians (Drs Erickson, Kohen, and Smith) are general pediatrie practitioners in addition to being behavioral pediatrie subspecial is ts, and the pediatrie psychologist (Dr Kuttner) has had years of experience on the firing line with one of the most stressful of chronic pediatrie problems, malignancies in children.

For practitioners who wish to pursue training in hypnotherapeutic methods or biofeedback, the Table lists names and addresses of organizations or programs with excellent workshops in these areas. For those who would like to view a teaching videotape that demonstrates Cyberphysiologic strategies, we recommend Dr Kuttner's videotape, "No Fears, No Tears," available through the Canadian Cancer Society.

Table

CURRENT RESEARCH

There is much clinical evidence that the successes related to the practice of cyberphysiologic strategies are somehow dependent on changes in mental images. There is little hasic information about mental processes in the construction of images, and most reported research is limited to laboratory studies of visual images in adults.1·2 There is evidence of individual differences in how images are constructed, and how memory images are recalled in adults. It seems likely that varying experiences with respect to culture, education, television exposure, and language might affect the development and application of imagery. Research in this area related to cyberphys io logic training may provide pediatricians with more precise guidelines in terms of what methods to teach, preferred ages to deal with, and reinforcement requirements. There has been a great deal of laboratory and clinical research with respect to using nonpharmacologic methods for primary or adjunct pain control in children see "Applications of Cyberphysiologic Techniques in Pain Management" by Dr Erickson, pp 145-155). Adding more specific information about assessment of imagery processes for individual children in nonpharmacologic pain management is an important goal.

There is currently much public interest in psychoneuroimmunology. Animal laboratory research and human epidemiology research have addressed the question about whether Stressors result in impaired immune responses.3,4 Although there is evidence for this, it is insufficient to prove that such impaired responses are clinically significant. We also lack information regarding exactly how clinicians would prescribe self-regulation interventions to change the clinical course of an illness. Perhaps an example of a clinical problem most reliable in responding to a cyberphysiologic intervention is the problem of warts. There are numerous reports regarding the association of self-hypnosis training and wart regression in both adults and children.5,6 The only reported controlled studies of voluntary immunomodulation in humans have been done with children and adolescents.7,8 These studies demonstrated that healthy children and adolescents had changes in salivary immunoglobulin A levels or…

An important task of child health professionals is to facilitate a sense of mastery and competency in the children they see and to encourage children to take responsibility for health and related behaviors. Learning to use Cyberphysiologic strategies appropriately increases the ability of child health professionals to do this. Applications may range from helping the child to cope with his or her anxiety over a minor procedure to controlling habit problems, to reducing performance anxiety, or to controlling chronic pain. Child health professionals may also personally benefit from learning and practicing specific relaxation methods.

The term cyberphysiology derives from the Greek word kybeman, meaning to steer or take the helm. The concept of helping children steer or take the helm with respect to problems related to pain, habits, or performance is central to the discussions in this issue. The articles that follow provide not only general information regarding types of applications, but also specific examples of some strategies the reader might begin using immediately. Each of the guest authors is an active clinician. The three pediatricians (Drs Erickson, Kohen, and Smith) are general pediatrie practitioners in addition to being behavioral pediatrie subspecial is ts, and the pediatrie psychologist (Dr Kuttner) has had years of experience on the firing line with one of the most stressful of chronic pediatrie problems, malignancies in children.

For practitioners who wish to pursue training in hypnotherapeutic methods or biofeedback, the Table lists names and addresses of organizations or programs with excellent workshops in these areas. For those who would like to view a teaching videotape that demonstrates Cyberphysiologic strategies, we recommend Dr Kuttner's videotape, "No Fears, No Tears," available through the Canadian Cancer Society.

Table

TABLEOrganizations Sponsoring Training Workshops

TABLE

Organizations Sponsoring Training Workshops

CURRENT RESEARCH

There is much clinical evidence that the successes related to the practice of cyberphysiologic strategies are somehow dependent on changes in mental images. There is little hasic information about mental processes in the construction of images, and most reported research is limited to laboratory studies of visual images in adults.1·2 There is evidence of individual differences in how images are constructed, and how memory images are recalled in adults. It seems likely that varying experiences with respect to culture, education, television exposure, and language might affect the development and application of imagery. Research in this area related to cyberphys io logic training may provide pediatricians with more precise guidelines in terms of what methods to teach, preferred ages to deal with, and reinforcement requirements. There has been a great deal of laboratory and clinical research with respect to using nonpharmacologic methods for primary or adjunct pain control in children see "Applications of Cyberphysiologic Techniques in Pain Management" by Dr Erickson, pp 145-155). Adding more specific information about assessment of imagery processes for individual children in nonpharmacologic pain management is an important goal.

There is currently much public interest in psychoneuroimmunology. Animal laboratory research and human epidemiology research have addressed the question about whether Stressors result in impaired immune responses.3,4 Although there is evidence for this, it is insufficient to prove that such impaired responses are clinically significant. We also lack information regarding exactly how clinicians would prescribe self-regulation interventions to change the clinical course of an illness. Perhaps an example of a clinical problem most reliable in responding to a cyberphysiologic intervention is the problem of warts. There are numerous reports regarding the association of self-hypnosis training and wart regression in both adults and children.5,6 The only reported controlled studies of voluntary immunomodulation in humans have been done with children and adolescents.7,8 These studies demonstrated that healthy children and adolescents had changes in salivary immunoglobulin A levels or in neutrophil adherence that were significantly associated with training in self-hypnosis. Once again, it is too early to make judgments about clinical publications from these laboratory studies. It seems more productive to continue research in this important area with children because they learn selfregulation methods more quickly than adults do, and one could assume that fewer variables related to diet, medications, lifestyle, and previous illnesses are operative. Currently, a national consortium study involving eight pediatrie institutions is conducting a controlled study of wart regression in children. Interventions will include relaxation- biofeedback, pharmacologie, and delayed treatment regimes.

Some clinical evidence supports the concept that early training in se If- regulatory skills via self-hypnosis or biofeedback may be an important diseaseprevention tool in pediatrics. Long-term studies will be needed to establish whether this is true. Such studies will benefit by improved miniaturized monitoring and feedback technology that would provide feedback to children in their usual places of activity -the school, the playground, and the home - rather than basing conclusions on performance in artificial laboratory settings. In the meantime, pediatrie practitioners will benefit themselves and the children they serve by learning to teach cyberphys io logy.

REFERENCES

1. Kosslyn SM, Magulis JA, Barrett AM, Goldknopf EF, Daly PF. Are differences in imagery abilities. Child Dev. 1990;61:995-1010.

2. Kosslyn SM. Aspects of a cognitive neuroscience of mental imagery. Science. 1988;240:1621-I626.

3. Irwin M, Daniels M, Bloum ET, Smith TC, Werner U. Life events, depressivisymptoms, and immune function. Am J Psychiatry. 1987; 144:437-4-11.

4. Malnechuk T. Emotions, brain, immunity, and health: a review. In: Glynes M. Penskepp, ] (cds). Emotions m Psychopathology. New York, NY: Plenum Press; 1988:181-247.

5. Thomas L. Warts. In: The Medusa and the Snail. New York, NY: Viking Press; 1979:76-81.

6. Noll RB. Hypnotherapy of a child with warts. J Dev Behav Pediatr. 1988;8:357-358.

7. Olness K, Culben T, Uden D. Self- regulation of salivary immunoglobin A by children. Pediatrics. 1989;83:67-71.

8. Olness K, Hall HR, Minnes L. Voluntary irnrnunomodulation in adolescents (abst). Pediatr Res. 1989;25:17a.

TABLE

Organizations Sponsoring Training Workshops

10.3928/0090-4481-19910301-05

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