Seattle Institute for Sex Therapy, Education, and Research

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Biofeedback as a Tool to Aid Recovery from Trauma

Survivors of any kind of sexual trauma - be it rape, incest, or any other kind of non-consenting or exploitative sexual activity - very often are left not only with psychological scarring, but also psychophysiological damage. Inability to sleep at night, excessive drinking, and binge eating are all quite common. What this all adds up to is stress. We all live with stress to one degree or another: the twentieth century has been called The Age of Anxiety. All stress is not harmful. As a source of motivation, stress can spur us on to creative work and it can enrich our pleasurable activities. However, stress resulting from sexual trauma is never beneficial, and often requires professional treatment to aid in recovery. The development of practical relaxation skills emphasizing strengthening an internal locus of control can be facilitated by biofeedback. This article will discuss how biofeedback can be used to integrate relaxation training with increased internal control of physiologic responses, and how this, in conjunction with sex therapy, can help clients recover from sexual trauma.

PITFALLS OF TRADITIONAL RELAXATION TRAINING

When working out treatment plans, it is helpful to give the client some sort of stress management training, either by loaning them tapes on progressive relaxation or by some kind of in-office instruction on relaxation. It is often assumed that the client having listened to the tapes, or having gone through a few sessions in the office, is thus able to have increased means of coping with her/his stress. This is often not the case: even if the client has followed the instructions carefully, and now appears relaxed, she/he may still be unable to relax to any appreciable degree, especially when confronted with daily stressors. Why is this? I believe it is because not enough time is dedicated to teaching the client the subtleties of relaxing under varied circumstances. This may include confronting denied emotions, and detecting and managing early signs of anxiety-producing thoughts. How can the therapist teach and know that the client is learning the necessary skills? The answer to this question is, I believe, biofeedback.

BIOFEEDBACK ASSISTED RELAXATION

At Seattle Institute for Sex Therapy, Education, and Research, we use biofeedback to assist our clients in a number of ways. One method is skill training using biofeedback-assisted relaxation protocols. The goal here is to learn to detect, identify, and experience physiological status and change this status toward relaxation. Once this is accomplished we go on to teach our clients generalization training so that they develop accurate self-perception in the absence of instrument-assisted feedback. The ultimate goal is to take generalization self-regulatory skills from practice in the therapist's office (or at home) to real-life environments where instrument-assisted feedback is not possible. This requires self confidence in self-physiological perception and in self-regulatory physiological change.

BIOFEEDBACK ASSISTED TRANSACTIONAL PSYCHOPHYSIOLOGY

Another exciting application for biofeedback is its use in transactional psychophysiology. This allows the therapist to monitor subtle subconscious arousal responses while interacting with the client. One of its uses is eliciting abreactions and confronting denied emotions. This application of biofeedback allows significant improvement in the shortest treatment time. Clients who have been in therapy for a year or more, blocked with denied emotions, are often able with the skills of relaxation and the use of biofeedback-assisted transactional psychophysiology to identify and get beyond previous stumbling blocks.

SPECIFIC MODALITIES OF BIOFEEDBACK

There are many modalities available to the therapist interested in biofeedback-assisted treatment. We use the following three modalities:

1. Electrodermograph (EDR)
2. Temperature
3. Electromyograph (EMG)

The two most useful modalities are Temperature and EDR. We use EMG mostly for treating muscle tension-related problems such as tension headaches.

Traditionally EDR has been called Galvanic Skin Response (GSR). The skin conductance measure has two primary characteristics. First, the slower changing tonic levels are thought to be an index of the general level of arousal in the sympathetic nervous system: the higher the skin conductance levels, the higher the level of arousal. The second, shorter, and more abrupt phasic response are thought to be associated with short-term stimuli such as thoughts or external events. At our clinic sessions we display to the client the ongoing and instantaneous activity of skin conductance. This feedback informs the therapist and the client of the activity patterns of her/his nervous system. This enables the client to become aware of nervous system activity normally outside the domain of sensory awareness. When used within a learning framework, the feedback reinforces and provides discriminative cues for the control or self-regulation of either general levels of arousal or emotional responsivity to specific thoughts or events. When we use the feedback in a desensitization framework, it provides the therapist and client with an index of the level of arousal to a specific item in the hierarchy, and can be used to guide the desensitization process.

The temperature (thermal) module is used to provide an indirect measurement of peripheral cardiovascular activity, and, in turn, sympathetic nervous system arousal. The vessels (arterioles) which supply blood to the periphery are surrounded by smooth muscles which are innervated by the sympathetic branch of the autonomic nervous system. With sympathetic arousal or activation, the muscles in the vascular beds constrict (vaso-constriction) resulting in a reduction in peripheral blood flow and ultimately a reduction in tissue temperature. With decreased sympathetic activity, the muscles in the vascular beds relax (vasodilation) resulting in an increase in peripheral blood flow and ultimately an increase in tissue temperature. We monitor general levels of stress with this modality, thus allowing us to compare the data with normative data within and across sessions.

UNIFIED BIOFEEDBACK APPROACH IN SEX THERAPY

A fundamental shortcoming of most relaxation training is that the skills training focuses on the relaxation end of the relaxation/stress continuum. The implication is that teaching stress reduction techniques reduces the individual's experience of stress and aids in adjustment. It is my experience that the stressors specific to each client - conscious or subconscious - must be exposed and explored before control of either can be accomplished.

Copyright © 1999 by Terence Skeates, Ph.D.(c) Biofeedback Therapist

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