Self-Regulation Therapy
Karen Olness
I. Background and introduction. Training in self-regulation can prove useful for pediatric clinicians and for the children and adolescents they serve. Training in self-regulation techniques provides a sense of mastery and coping abilities for children. Controlled studies have increasingly provided evidence for the effectiveness of such training in conditions such as prevention of juvenile migraine and irritable bowel syndrome and anxiety associated with medical or dental procedures. Early training in self-regulation can extinguish negative conditioned physiological responses such as tachycardia or hyperventilation and thereby avoid more complex adult problems. The average child can learn self-regulation techniques quickly, and initial training requires only a few office visits.
A. Definitions.
1. Hypnotherapy refers to focusing attention on specific mental images for therapeutic purposes. It often, but not always, involves relaxation. Children, for example, may be physically active when practicing self-hypnosis. All hypnosis is, in fact, self-hypnosis although the term hetero-hypnosis is used to refer to the training period when the child is being taught self-hypnosis. Pediatric clinicians who teach self-hypnosis to children must consider each child’s interests, learning styles, and imagery preferences.
2. Imagery. This term is often used for training in self-regulation. It is important that teachers of imagery recognize that mental imagery preferences vary among individuals. Although most children are skilled in visual imagery, many prefer to focus on auditory, kinesthetic, or taste/olfactory imagery.
3. Biofeedback provides visual or auditory evidence of physiological changes. A bathroom scale and a blood pressure monitor, for example, are biofeedback devices. Many child appealing small biofeedback devices have been developed, which provide feedback of peripheral temperature, galvanic skin resistance, heart rate, heart rate variability, and/or muscle responses. Neurofeedback requires larger equipment. In order to effect changes in physiological responses, children and adolescents are taught self-hypnosis strategies such as favorite place imagery or kinesthetic imagery or progressive relaxation.
II. Self-regulation in pediatric care.
A. Applications. The pediatric clinician may recommend training in a self-regulation method as primary or adjunct treatment for a number of problems (Table 19-1). These include habit problems such as hair pulling, thumb sucking, or nail biting; chronic illnesses including asthma, hemophilia, diabetes, cancer, or migraine; performance anxiety including sports, examinations, musical performance, and speaking; and enuresis, warts, conditioned fears and anxieties, sleep problems, pain associated with procedures, chronic pain, and attention deficit disorders. The addition of biofeedback to training in self-hypnosis makes the training more interesting for many children and helps them to understand that by changing their thinking, they can control body responses.
B. Principles of self-regulation treatment.
1. Assess the presenting problem to rule out causes that may require other types of treatment such as enuresis associated with constipation or a urinary tract infection.
2. Assess the interest of the child and his or her willingness to practice self-regulation techniques. If the problem is of primary concern to the parent, rather than the child, the child may not wish to invest the requisite practice time.
3. Determine the child’s interest, likes, dislikes, fears, and learning patterns to choose an approach that is likely to be appealing and practical.
4. Because practice is the job of the child, not the parents, teach the child without the presence of parents in most cases. Parents may be present during the initial part of the interview. The pediatric clinician might say, in the presence of both the child and parent, “Your mother is not allowed to remind you to practice. On the way home
the two of you can discuss a way to remind yourself to practice, for example, a sign on your bedroom door.”
Table 19-1. Applications of self-regulation in pediatrics
Pain management
Acute (procedures in office or emergency room)
Chronic (sickle cell disease, hemophilia, recurrent headaches, etc.)
Habit problems
Thumb sucking
Hair pulling
Simple tics
Enuresis
Habit cough
Reduction of anxiety in chronic conditions
Malignancies
Hemophilia
Sickle cell disease
Lupus erythematosus
Tourette’s syndrome
Diabetes
Cyclic vomiting
Improved performance
Sports
Drama
Music
Exams
Control of conditions involving autonomic dysregulation
Raynaud’s phenomenon
Reflex sympathetic dystrophy
Dyshidrosis
Conditioned hyperventilation
Conditioned dysphagia
Prevention
Migraine
Anxiety
Other
Insomnia
Parasomnias
Warts
Disfluencies
Conditioned hives
Fears (e.g., flying)
Eating problems
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