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  4. Can you recommend some biofeedback resources? Which devices do you use, and how would you approach implementing this?”

Can you recommend some biofeedback resources? Which devices do you use, and how would you approach implementing this?”

Dr. Amy Nett: For biofeedback, I like HeartMath. I think that’s a good one that most people are able to use. For some people, I’ll actually suggest that they purchase it and bring it to the office, and I’m happy to spend a session going through that with people. If people are willing to use their appointment time for that, I think that’s a great option. Make sure that people know their goals need to be realistic. I think that’s one of the most important things when you’re starting to use biofeedback or a mindfulness-type practice. For biofeedback, HeartMath, I like that.

Another resource I use a lot is Jon Kabat-Zinn. He has a book called Full Catastrophe Living. It’s available also as an audiobook for people who like to listen and multitask. Some people can’t get through it. It is a really thick book. It’s a great resource, but if they can’t, that’s OK; I give them some of the highlights from that or suggest that they use guided meditations. Jon Kabat-Zinn also has some incredibly wonderful guided meditations. They do cost money. They’re not free. There are also some free guided meditations online. Those are other options.

Again, I sometimes will go over a mindfulness practice, a very basic mindfulness practice, with patients in the office, just belly breathing, spending a few minutes with them kind of doing a guided meditation, having them focus on what the breath feels like at their nostrils as it comes in and out, and just giving them different ways for a very simple meditation or mindfulness practice. In terms of implementing this with patients, number one, let them know that this is the most difficult piece of treatment to implement for almost everyone and to set realistic expectations. Their goal might be to start with two minutes per day of biofeedback or a mindfulness practice and to increase it only very slowly. Let them know that it’s easy, that their mind is going to wander, that they’re going to feel like they’re not doing anything, especially if they choose an approach that doesn’t have biofeedback, where they’re not getting that positive reinforcement of the light going from red to yellow to green.

I oftentimes also will give people the scientific data to let them know there are changes, there are physiological changes. One of my favorite studies is looking at how meditation actually changes the brain, and we can see that on functional MRI. Letting people know that there are actual structural changes in the brain due to meditation sometimes really motivates people because otherwise they’re very unclear on why they’re sitting there quietly for two minutes when they feel like they could be answering emails, paying bills, that sort of thing.

Again, providing patients with information, data explaining that there’s an actual reason you’re suggesting that, that’s how I generally approach implementing it. It is very hard, and I do tend to make it one of my regular questions. Whenever I follow up with people who need that support, I do ask them, “How’s your meditation going? How’s that practice been looking?” Sometimes people say, “Oh, I fell of the wagon. Thanks for the reminder. I’m going to start again.” We all fall off of meditation. It’s hard to to.

Hopefully that answers your questions about biofeedback and resources. HeartMath, Jon Kabat-Zinn. If stress is an issue, sort of coming outside of addiction, another book I really like is When the Body Says No by Gabor Mate. That’s a good one that I’ll sometimes recommend to patients, and sometimes the classic Why Zebras Don’t Get Ulcers is another good book for patients who want a little more of the background on that and sort of the value and the physiology behind it.

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