Individualized Medicine with No Side Effects? It’s Already Here

February 16, 2018

We live in an age of personalization, and medicine is increasingly part of that trend. Recent advances in genetic research have allowed medications to be tailored to a person’s DNA profile, for example. But another form of ‘individualized medicine’ has been around far longer: biofeedback, a therapeutic intervention in which patients are trained to recognize and modify their biorhythms. Using electronic monitoring, biofeedback practitioners help patients become aware of patterns in their brain waves, heart rate, breathing, muscle tension, or other physiological responses, and train them to modulate those patterns. Biofeedback has flown under the radar of many clinicians and patients, but it is becoming more common and accepted, thanks in part to growing studies on its effectiveness by researchers like psychologist Genomary Krigbaum. Krigbaum, who practices and studies biofeedback for a range of conditions from pain management to Attention Deficit Hyperactivity Disorder (ADHD) to insomnia, is motivated by the results biofeedback can have in improving patients’ health and quality of life.

Typically, treatment begins with a clinician attaching electrodes to the patient that gather and send information to an electronic monitor. A computerized algorithm turns that information into output the patient can see or hear in the form of an audible tone, visual chart or graphics, or other metrics. The clinician then usually helps the patient learn strategies that can help change the physiological response, such as deep breathing or tensing and relaxing muscles. Sometimes the patient simply listens to an audible tone timed to approximate the desired biorhythm. As patients go through this process, they can watch or hear the feedback to see if their physiological response is changing, for example if their heart rate or pulse is slowing down. Through this process, the clinician trains the patient to achieve (or get closer to) a ‘normal’ pattern, which can be determined by the standard or normed level for other patients undergoing that specific treatment or by the patient’s personal ‘best’ point of performance (or the point at which he believes to be his best).

Krigbaum’s work has been influential, in part, because of her emphasis on individualizing that process. Typically, clinicians try to get patients to reach a level determined by the mean of the overall population. But Krigbaum points out “everybody has a different baseline” and the baseline for one person might be different than the mean of the population. It shouldn’t always be the goal to get patients to the population average, she says. To make biofeedback more individualized, for example, she has used inferential statistics to analyze how patients progress over the course of their treatment, in terms of both their physiological responses and the symptoms they experience. By triangulating those metrics, the clinical picture of change can sometimes be more meaningful, especially for the patient’s well-being, than relying strictly on endpoint comparisons of the patient and the population average.

Krigbaum believes clinicians and the health community are becoming more open to biofeedback interventions, which have few, if any, side effects or complications. In addition to her research and clinical work, she consults with physicians and mental health clinicians and trains medical students and future psychologists. Much of her teaching focuses on viewing patients as individuals and understanding how their unique physiology, experiences, and circumstances influence their conditions and effectiveness of treatments. She advocates for a multicultural perspective on diagnosis and treatment, recognizing that, for example, different cultures have different conceptions of pain or beliefs about what is appropriate to tell a doctor. Additionally, patients’ social and environmental circumstances can influence their symptoms and ability to stick to treatment regimens. For example, Krigbaum explains, chronic stress can have a serious impact on immune functioning, diabetes, and other medical problems, but clinicians do not always ask about patients’ social circumstances. “We traditionally train them to aim for an objectivity that could be construed as ‘detachment,’ but then they often won’t see the full picture of what is going on. I aim to teach them about social ecosystems” so that they don’t misdiagnose a problem or overlook a cause. She adds that a lot of clinicians tend to seek immediate certainty, but the answers can sometimes be found by exploring ambiguity. Examining patients’ unique experiences is critical, she says, because “in the middle of subjectivity, there is always objectivity.”

Genomary Krigbaum is a recipient of the Federation of Associations in Behavioral & Brain Sciences (FABBS) Early Career Impact Award, to be presented during the 2018 annual meeting of the Association for Applied Psychophysiology and Biofeedback in Orlando, Florida.