Symposium 121 - Innovative Psychological Approaches to Assessing and Treating Pediatric Patients With Autonomic Dysfunction
Category: Health Psychology / Behavioral Medicine - Child
Presentation Type: Symposium
Introduction: Biofeedback is one modality of treatment which offers promise for Postural Orthostatic Tachycardia Syndrome (POTS). Prior small N studies and case studies support biofeedback can enhance autonomic functioning and increase self-regulation, leading to symptom reduction and improved functioning.
Method: A case series design demonstrates the application of biofeedback in three patients admitted to an intensive pain rehabilitation program. Each patient received a psychophysiological assessment and at least 4 treatment sessions targeting self-regulation. Training targeted controlled respirations and associated changes in heart-rate-variability (HRV). Biofeedback data across sessions are presented for review.
Results: Patient 1 (16 y.o. female) demonstrated poor cardiorespiratory functioning, both in resting, stressor and relaxed conditions. With training, respiratory rate (RR) improved from 20.1 to 9.3 and HRV (LF%) from 31.08 to 73.68 with very brief intervention. Patient 2 (19 y.o. female) demonstrated adequate cardiorespiratory functioning at rest, but not in a relaxed condition. With training, RR improved from 18.7 to 10.4 and HRV (LF%) from 39.80 to 80.61, using graduated paced breathing technique. With continued training, RR improved to 7.8 and HRV (LF%) to 82.48. Patient 3 (14 y.o. female) demonstrated poor cardiorespiratory functioning, both in resting, stressor and relaxed conditions. With training, RR improved from 21.0 to 8.7 and HRV (LF%) from 56.51 to 95.40. Gains were not maintained without biofeedback, but RR of 7.95 and HRV (LF%) of 81.84 were maintained with minor computerized guidance.
Conclusion: Data support that children with POTS develop physiological awareness using biofeedback. These children also demonstrate enhanced self-regulation of physiological measures. Biofeedback shows promise as an intervention to enhance self-regulation and symptom management for children with POTS. However further controlled research is warranted to strengthen findings and clarify the model for biofeedback influencing symptom reduction (e.g., modified set-point, greater autonomic balance). Suggestions for further research will be discussed.