Evidence indicates that for many forms of chronic illness, the general dysregulation and drain of the illness experience can be reflected in decreased coherence. In addition, many individuals with chronic illness experience various forms of stress related to the chronic illness experience (academic, job, financial, social, physical) which can further amplify either core symptoms or related feelings of fatigue, malaise, etc. Feeling hopeless and or ineffective, these patients are also at risk of developing negative emotions which may further complicate things by promoting unhelpful neurohormal and immune events that can interfere with recovery.
There is new evidence that HRV training, breath control and engaging positive emotions may impact specific conditions such as airway reactivity in asthma, glycemic control in diabetes, blood flow in sickle cell anemia, and effect positive changes that promote immune function in conditions such as cancer and atopic dermatitis. It has long been acknowledged that although negative emotions and stress don’t cause inflammatory bowel disease, they likely play a role in exacerbation and maintenance of symptoms for many. The emWave PC/Mac Stress Relief System has been used successfully with patients have the following conditions:
Children and adults with a variety of chronic illnesses often share the feeling of a sense of loss of control as part of the ongoing chronic illness experience. One of the benefits of using the FFISL and the Quick Coherence technique is that these approaches give back some measure of control over the chronic illness and that alone has important therapeutic impact. Many patients greatly appreciate the ability to master a technique that allows for some self-management of symptoms commonly associated with chronic illness such as pain, stress and insomnia. In addition, because often times these patients are on multiple medications, adding an effective tool that is safe and non-pharmacological is particularly welcome.
Author's Commentary: Over the past several years a number of studies have reviewed the pivotal role that emotional regulation (or lack thereof) can have on the clinical course of asthma and the frequency of exacerbations and need for hospitalizations. Mind/body techniques can be very helpful in modifying the course of asthma and in providing tools for individuals with asthma to better manage long-term health as well as acute events; in some cases reducing or eliminating the need for bronchodilating agents. Some children and teens with asthma develop other complicated breathing problems such as paradoxical vocal cord adduction, where the vocal cords inadvertently close during inspiration creating an uncomfortable feeling of tightness or shortness of breath which is not medication responsive. For most children who experience this, there is a psychophysiological state of inter-related phenomena that seem to bring this on, including stress as a common mediating factor.
Janelle was a 16 year old competitive figure skater referred by the pulmonology group with a diagnosis of asthma complicated recently by paradoxical vocal cord adduction (also called vocal cord dysfunction or VCD). Janelle was finding her daily practice and also performance at skating competitions was being affected by her experience of shortness of breath that was related to VCD and therefore not responsive to her usual asthma medications. This resulted in decreased stamina and had an impact on her ability to finish a full routine without becoming fatigued and short of breath. She felt “driven" to do well in figure skating, admitted to stress secondary to her strict schedule and was finding it less “fun” at times. Her goal was to compete successfully at a national level. She was also a straight “A” student in high school.
In reviewing the etiology of VCD we reviewed the basic sequence we think happens to most individuals that we see. First of all, increased levels of recurrent stress may lead to more thoracic breathing patterns and a tendency to “brace” or tighten the muscles in the upper body-shoulders, neck and even face. With these muscles being tighter, particularly at times of increased aerobic activity where you are breathing harder, a basic “dys-coordination” occurs whereby the tightened neck muscles and thoracic breathing contribute to a situation where the vocal cords inappropriately close (adduct) partially during inhalation causing resistance to air flow. This is experienced as tightness and shortness of breath. This feeling in turn may increase anxiety even “panic” feelings which can drive the cycle further in the wrong direction. This is commonly at first attributed to the underlying asthma which can be exacerbated by exercise. However, in the case of VCD, it is not medication responsive and requires an undoing of this habituated pattern of stress, muscle tightness, thoracic breathing and negative expectation and emotional “dysregulation” with symptoms of anxiety.
For Janelle, training in progressive muscle relaxation (with special attention being given to the shoulders, neck and face muscles) was combined with training in quick coherence/freeze framer HRV techniques and resulted in an excellent impovement over a 12 week time frame. She was taught to practice diaphragmatic "heart focussed" breathing first in resting, sitting and standing positions, and then taught to breathe more comforatbly and fully with positive expectations while engaging in increasingly higher levels of aerobic demand (skating slowly at first and then gradually with more intensity). She was gradually able to breathe much more comfortably again while skating with increased confidence and improved performance. Daily use of the Quick Coherence technique and related stress management approaches were also suggested as a way to manage day-to-day background stress which was also felt to be a contributing factor.
Author's Commentary: Children, teens and adults with chronic illness experience significant emotional distress both in the acute phase but also in long term followup. Experience suggests that mind/body approaches can be very helpful as symptom management adjuncts for cancer patients with stress, pain, insomnia and nausea as well as emotional coping and indirectly promoting immune function through positive affect.
From a mental health perspective, cancer survivors may experience significant stressors as late sequellae of treatment and have a higher incidence of PTSD symptoms. In our practice, we have found that survivors of childhood cancer can struggle with PTSD, mood problems, survivor guilt, and chronic stress. Mind/body skills approaches which include emotional regulation and stress management are key tools for these individuals and provide a foundation for enhanced health and wellness as they move forward. This case nicely illustrates a number of these issues.
Steve is a 19-year-old first year college student who is a long-term cancer survivor. Steve has long term sequellae from his cancer which include depression, bedwetting, and insomnia, as well as experiences of multiple stresses from financial strains and interpersonal difficulties with family and peers. He began working with both a behavioral pediatrician and a pediatric psychologist 2 years ago with a goal of enhancing overall functioning and improving stress management and overall coping skills. Steve found that anxiety and stress issues were contributing to ongoing problems with symptoms such as insomnia and emotional lability.
Early on in the course of treatment he was introduced to the emWave PC/Mac Stress Relief System as well as the Quick Coherence technique. He then used the emWave PC/Mac Stress Relief System at home for a period of six weeks. He utilized the emWave PC/Mac Stress Relief System on his laptop computer every day for that period of time and developed an excellent ability to achieve a state of high coherence quickly and consistently. Despite ongoing stressors he found that using emotional self-regulation techniques he experienced a much greater ability to handle stress, was less moody and had better control of maintaining a positive affect. His problems with insomnia improved as well as his overall health status during this time. He also experienced improvements in his interpersonal relationships secondary to his enhanced ability to manage frustration and stress. He continues to use these strategies on a daily basis at college.