- How well do NeuroBehavioral Programs actually work when compared with other behavioral medicine programs?
- How would referring my patients benefit my patients and my practice?
- Is this hypnosis?
- Is this cognitive-behavioral therapy?
- How does neurobehavioral work differ from interactive guided imagery?
- Does this program work for acute and chronic pain? For what physical conditions?
- Are there predictor variables for who does well with the NeuroBehavioral Programs approach?
Q. How well do NeuroBehavioral Programs actually work when compared with other behavioral medicine programs?
A. The NeuroBehavioral Pain Management Program was built inductively based on outcomes of training more than 700 patients and has gone through six revisions. All patient outcomes, using the sixth version, have been recorded in a matrix for research purposes. A review of the last 60 cases using the latest version of the program shows that more than 90% of patients experience some pain reduction during the initial session.
Patient logs report that the duration of relief ranges from 2 to 12+ hours in the first of three levels of skill. Patients typically report subjective improvement in sleep, mood, and interpersonal functioning as stress and negative emotions are eliminated using this holistic intervention system.
When compared to the results of programs that train patients in meditation, biofeedback, hypnosis, and relaxation strategies, these results show the NeuroBehavioral Pain Management Program to be the most effective form of behavioral medicine intervention.
Q. How would referring my patients benefit my patients and my practice?
A. We believe the NeuroBehavioral Pain Management Program can benefit your patients and your practice in the following ways:
Efficiency of care. Physicians who are not in specialized pain programs report that chronic pain patients, 80% of whom may be moderately depressed, are heavy users of medical treatment time. Working with a NeuroBehavioral practitioner distributes this care, lessens patient depression, and can reduce office visits for often intractable conditions.
Reduction in patient dependency. The home program enables patients to immediately transfer skills out of the office into the home and work environment. Patients who use NeuroBehavioral Programs will require less time in the office for treatment.
Ease of use. The NeuroBehavioral Pain Management Program can work for the most passive participant. The home program with its simple progressive instructions can be used to reduce physical and emotional pain and stress with 10 to 20 minutes of practice per day. The later stages require no time at all. The home program allows the patients to immediately transfer skills out of the office into the home and work environment.
Complementarity. The NeuroBehavioral Pain Management Program is a complementary program that supports and enhances other treatment plans. In comprehensive pain management programs, a NeuroBehavioral Programs practitioner can provide a valuable adjunctive service.
Convenience and availability. For added convenience, the treatment program can be provided by telephone with the same high rate of effectiveness, making the program accessible to the disabled and those unable to travel. A certified NeuroBehavioral Programs practitioner will see or consult by telephone with your referral within a few days of your request. Backing these therapists is a full-time administrative staff person who can secure authorization for the patient and deliver progress reports to you via e-mail, snail mail, or fax, usually within 24 hours of the session.
Possible reduction of medication dependency and costs. Many patients have elected with medical supervision to reduce their reliance on medication after achieving pain relief using NeuroBehavioral Programs.
Q. Is this hypnosis?
A. No, this is not hypnosis. We believe hypnosis may depend on the same underlying neural mechanisms and the process of information transduction in turning verbal instructions into physical-emotional outcomes. The NeuroBehavioral Pain Management Program requires neither trance induction nor focused awareness. Unlike hypnosis as it is popularly practiced, this process can be done in noisy, distracting environments without imagery or alterations in waking consciousness. The process works in the presence of powerful competing stimulation such as excruciating pain. In the more advanced phases of training, after stating the desired outcome, a patient can become absorbed in a completely unrelated task while the result develops without further attention.
Ideomotor signals, which are used in the first level, have been used in hypnosis for accessing yes or no answers to unconscious material. In NeuroBehavioral Programs, ideomotor responses are used in the early stages of training to signal readiness to create a psychophysical response and for therapist feedback in directing the training sessions. In the advanced stage of directly intending the desired outcome, these feedback responses are no longer used. In the final phase of training, the patient's readiness to create the symptom reduction response is assumed. The physical result is all the feedback that is needed. This allows the patient to simply say, “I want my pain to go to zero.”
Q. Cognitive-behavioral therapy uses self-statements to produce certain psychological effects. Self-statements or self-instruction to create physiological responses are here called neurobehavioral and fall under the larger category of behavioral medicine.
We have often found that patients can instruct themselves to change habitual emotional responses related to job loss or trauma. This aspect is like cognitive-behavioral work but does not use psychological counters, re-education of negative self-statements, or changing cognitive distortions.
Q. How does neurobehavioral work differ from interactive guided imagery?
A. We believe that the phenomenon of information transduction is the common mechanism underlying the effects of both interactive guided imagery and the neurobehavioral approach outlined here. Patients have generated imagery spontaneously during their relief procedures, but this isn't the focus of our work, which uses verbal instruction instead.
Q. Does this program work for acute and chronic pain? For what physical conditions?
A. While the program can be used for both chronic and acute pain, it is directed at chronic conditions. The NeuroBehavioral Pain Management Program has been used with both soft tissue injuries and structural orthopedic conditions requiring surgery. Cancer patients have made effective use of the process as well as those suffering from fibromyalgia, MS, and lupus, to name just a few conditions that may be helped by this approach.
Q. Are there predictor variables for who does well with the NeuroBehavioral Programs approach?
A. A review of predictor variables in research on pain management indicates that general anxiety or fearfulness and external locus of control tend to diminish patient initiative, treatment compliance, and consequent treatment outcomes.
Behavioral medicine and the NeuroBehavioral Programs approach are patient-driven. The patient, not medicine, is the agent of relief. Patient follow-through is expected in logging results and phoning the NeuroBehavioral Programs practitioner if home results vary from those obtained in regular treatment sessions. Patients must be motivated to feel better so that the planning, initiative, and effort necessary for the program to be successful can take place.
Interestingly, injured patients often become externally focused due to stress and will quickly reestablish a more internal locus of control when they experience success in reducing the noxious quality of the symptom.
A simple diagnostic tool for assessing a patient's level of motivation to become better and how mired a patient is in a symptom/despair cycle is to ask the patient: “How would your life be different if the symptom were gone? And how much relief would you have to have to do those things?” These two questions quickly expose the client's reasons to get better, frustration tolerance, zest for living, and self-absorption in the symptom.
