experiential learning

Basic biofeedback in pain management


I’m no techno-whizz in biofeedback – you have to speak to one of my colleagues (she knows who she is!) to get the technical data on things like heart rate variability – but I do use several modalities reasonably often. So today I thought I’d discuss some of the ways I use biofeedback with the people I work with.

Biofeedback basically provides visual or auditory information about normally undetectable physiological processes. It ranges from temperature sensors through to skin conduction (galvanic skin response), and includes surface EMG, respiration, blood volume pulse and sometimes these are put together to provide feedback on heart rate variability. I’m not going into HRV yet, that’s for another day!

The most common sensors I use
everyday are GSR, which is a reasonably sensitive measure of general arousal level; respiration because it provides immediate feedback on the way the person is breathing and is helpful for developing diaphragmatic breathing; BVP because it responds quickly to respiration and can demonstrate to the person the effect of slowing their breathing down; and I often use surface EMG because it can provide immediate feedback on posture changes (more…)

Advertisements

Group facilitation


I love working in groups! I love the diversity, and the way that learning occurs, and the challenges of energising and focusing groups. For me groupwork is one of the most demanding and yet rewarding aspects of my work.

There are many many sites on the internet that have a range of activities for groups – a good number of them are free. What they don’t seem to do is help with how to integrate the activities so they not only energise and warm a group up, but also provide a venue for serious learning.

I’m going to describe two activities that I’ve enjoyed using with groups who are developing pain management skills.

The first is used within the first week (often the second or third day), and the second is best used towards the end of a programme. The purpose of each activity is to allow the group to focus on the activity while forgetting about their pain, so that they can develop awareness of what their ‘high risk’ behaviours are with regard to learning new activities, integrating pain management strategies, and in a sense, how they live their life. I subscribe to the idea that ‘how you do anything is how you do everything’ – so how people participate in these activities is probably how they will respond to situations in the real world.

There are some common tasks as facilitator for both activities, and I’ll describe these as a preamble to the specific activities.

The purpose: to enable the group members to respond naturally to a ‘demand’ situation, to assist them to reflect on the way they approach activities (‘life’)

My role: facilitate, set task parameters, enforce ‘rules’ or boundaries, assist the group to reflect and generate their own learning, ensure the equipment and environment is established for mental and physical health

Pre-activity: set up environment, ensure the instructions are printed and clear, ensure all equipment is available, have stop-watch or timer set up, and that adequate time for both briefing and debriefing has been allowed for.

Post-activity: ensure all participants have had time to reflect, all have been facilitated to hear what you as facilitator think is important, and that group process has been allowed to flow, the participants have written down ‘key learnings’ from the session, and you have been able to clean up.

Group size: 4 – 9 participants

Activity one – ‘Crossing croc-infested waters’

Materials: 5 A4 sheets of paper, tape to mark floor

Preparation: tape a ‘river’ across the floor – the ‘river’ should be at least 3 m wide, and about the same deep (or as wide as your room!)

Instructions: Tell the group that they are required to cross the river which is full of crocodiles. They have five stepping planks that they can use to cross the river with, but because they’re made of wood and float, once they are placed down in the water, they must be held down with a foot at all times or they will be swept away! The group must rely on each other, and work out how to get all members of the group across the river safely using only the five pieces of paper. They must not allow anyone to ‘die’, neither can any part of their body touch the ‘river’ or it will be ‘eaten’. They have 10 minutes to complete this activity.

Facilitator role: It is very important to enforce that the pieces of paper must be held down at all times. This is often forgotten unless the group have rehearsed the activity on ‘dry land’, and learning to rely on each other and work together as a team, watching out for each other and coordinating their movements. The facilitator must also urge speed and maintain a watch on time, particularly as the activity nears the end. To make the task more difficult, the time can be made shorter, or a piece of paper can be removed. It’s also important that no-one puts their foot in the ‘water’ (or they may not put that foot down again – it’s been bitten off!)

At the end, the facilitator must conduct the debrief – see attached pdf doc.

Activity two – Radioactive Rice

Materials: two cups, one filled with uncooked rice, various items from around the room including sheets of paper, tape, spoon, icecream sticks, pottles, string, bluetac, chalk, instruction sheet

Preparation: draw a circle with chalk on the table (circle is usually about 1m radius). Place one cup filled with rice in the centre of the circle. Collect other assorted items around the table.

Instructions: Tell the group that this is a heavily disguised cup of radioactive rice that will blow up in 30 minutes, creating a huge crater of radioactivity and killing all within a 2km radius of the area. Inside the chalk circle is an invisible containment field shaped like a cylinder, going from ceiling through the table to ground level. This is currently holding the radioactivity inside it. The rules are:

  • No body parts are allowed to enter the containment area
  • No-one is allowed to commit suicide and sacrifice themselves to remove the rice
  • No items that are outside the room are allowed to be used
  • Anyone who breaks the rule is ruled out and cannot be physically involved from then on (not the word physically involved! it’s OK to talk…!)
  • As much or as little rice can be transferred at any one time
  • The group has 30 minutes to transfer the rice from one cup to the other, then to remove the second cup to the ‘safety zone’ before the whole area will blow up

I usually allow 5 minutes question time then I will stop answering any questions and allow the group to get to work.

After 30 minutes, time is up and it’s debriefing time.

Facilitator role: It’s very important to stick to the rules at all times, maintain a very close watch on the participants and firmly tell them they are out if they break the rules. Every 5 minutes for the first 15, count time, thereafter every one minute, and in the last two minutes, every several seconds. Ensure people who are ‘out’ don’t get physically involved – but remember they are allowed to remain in verbal participation! Managing the debrief is essential.

Debriefing: for both of these activities, debriefing is essential!

In each case, these activities represent ‘life’ – and how people go about managing their participation is very similar to how they will participate in ‘real life’. So, some people will work together with others, think and plan, and manage both themselves and their pain using a wide range of skills. Others will completely forget to manage their pain, jump right in and break the rules very quickly.

This document (activity-review-jan-2008.doc) can be used for individual review.

As well, the group can be facilitated to provide review to each other – this is a very powerful way for people to develop knowledge of each other, and to learn to give and receive feedback (positive and negative). I usually start with asking the group ‘what did you do well?’, and ‘what would you do differently?’, then I ask the group to contribute both types of feedback, and finally, ask the person ‘what will you take away from this experience today?’.

Often it’s helpful to reflect on ‘what happened when I was counting the time down?’ – it’s adding pressure, and mimics a working situation.

Asking ‘and what happened to your pain during the task?’ reminds people of the usefulness of distraction, and that it can be a trap because pain becomes more problematic afterwards. Most people forget to use pain management strategies, so it can be a potent learning tool to remind them that they need to integrate pain management strategies even during activities like this that are involving and distracting. I also like to remind people that they always had a choice – they could have told me that this activity was silly, not real, and chosen not to participate! But they may have missed an opportunity to learn something – which is pretty much what life is like!

Reflecting on ‘What did it feel like when you were told you were out?’ is a powerful experience – many people say that they felt gutted, stunned, angry, and some argue against the rule. It’s useful to draw the parallel with the experience of suddenly having pain, when all the physical things they used to do were restricted (but equally powerful to emphasise that people were still able to contribute verbally – many people don’t remember this, and it can be both humbling and empowering for people to realise that they self-limited their involvement by not clarifying their position).

At the completion it’s important that participants write down their take-home messages – it’s impressive how many are aware even at the beginning of a programme, exactly what their particular pain management ‘trip-ups’ will be, but equally impressive to notice that even by the end of the programme, they will still fail to integrate their skills.

I hope you enjoyed this introduction to two activities I’ve used with people to help them learn experientially.