Intervention Protocols
Neuroplastic and Cognitive Restructuring Strategies work by:
Changing Behavior
- Circadian Rhythm and Sleep Protocol (Evaluation of sleep habits and behaviors and implementation of environmental and behavioral change)
- Nutritional Behavior Protocol (based on diagnosis and physician order)
Competing With or Restructuring Thought Patterns Impacting Recovery
- Anxiety Protocol for education on and identification of patient anxiety 'loops' and specific strategies and behavioral prescriptions to 'unwind' stress-inducing responses and its accompanied unhealthy behaviors (e.g. a diabetic patient carb-loading in response to stress). Steps include recognition/awareness of loops; the trigger and associated behaviors; noticing the results; disenchantment/curiosity building; and seeking healthier responses.
- Neuroplastic Brain and Pain Reduction Protocol (Neuroplasticity is the ability of the brain to modify its structure, biochemistry and function following changes in the body and/or the external environment). In this protocol, patients are educated on
The four pain rules of how the experience of pain is created in the brain
The three neuroplastic rules of how to compete with and reduce pain signals
What neuroplastic methods affect what brain centers and how to combine them
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This protocol engages the senses to compete with pain signals, reduce anxiety, modulate physiology and improve sleep. It utilizes combinations of clinically tested and hospital-safe scent, virtual reality imagery [sight], 3-D holographic nature sound, gentle touch/pressure, and breath work.
- Managing Voices Within Protocol (Teaching patient how to decouple the ongoing 'chatter' and automatic pilot mode of pain and disease-driven ruminations by mindful self-evaluation exercises practiced across the day). Tools to tame the ruminations are taught and implemented as behavioral prescriptions (3 environmental tools; 11 social tools; and 12 self-distancing tools, based on patient need).
- Critical Thinking Problem Solving Protocol is the use of a series of critical thinking tools to help patients make important medical or life effecting decisions while under extreme stress or in pain. In pain and stress, the executive function of the brain can ‘shut down’ and patients become frozen and unable to act or make complicated medical decisions. These tools walk the patient through a systematic process that allows for thoughtful decision making.
- EMDR Protocol (Eye Movement and Desensitization and Reprocessing) is utilized to treat disease-state trauma and responses or trauma that is worsening or interfering with recovery from a medical condition.
- Autogenic Relaxation Protocol (a form of physiologically based hypnotic imagery) is utilized for pain and anxiety reduction.
- Mindfulness Meditation Training Protocol is taught to reduce anxiety and conditioned responses to physical and emotional pain.
- Written Exposure Therapy (WET) for PTSD. This 5 session PTSD treatment approach is one of the most researched methods, and is the most gentle approach for treating PTSD. It is an alternative treatment to EMDR for patients who do not qualify for that form of trauma therapy.
- On rare occasion, Personality Inventory Training may be included in the treatment plan. The inventory improves communications skill with medical providers or with family members and others who may be a source of stress in the patient's life (e.g., interfering with patient compliance to self-care).
- BIOFEEDBACK methods that can be utilized safely at home (or in a hospital setting with physician approval) may also be implemented for reduction of anxiety and depression or for restoring brain rhythms.
EEG meditation monitoring
Heart Rate Variability monitoring (HRV)
Temperature control for vessel dilation (Finger Monitor).
Interactive Metronome (IM). The IM device is particularly helpful with cognitive deficits and balance issues post-stroke or other brain injury. NOTE: During COVID, this device is not being offered, as it requires intensive in-person sessions.
DEVICE TO REDUCE PAIN, ANXIETY AND SLEEP DEPRIVATION
An FDA approved device (The Alpha Stim) has been shown to reduce anxiety and physical pain and enhance sleep in four out of five patients. This device may be prescribed for patients, based on reduction of their symptoms during an assessment process. The Alpha Stim is tested in session and then used at home on a specified schedule and setting.
SELECTION OF PROTOCOLS
Selection of any of the above protocols, therapies or devices as part of a treatment plan is based on patient's symptoms, willingness to comply, and patient educational and comprehension level.
Example: The full protocol of Neuroplastic Pain Management, which is scientifically dense, would be provided in full for a patient with the education and interest to complete it. For a less educated or more impaired/traumatized patient, simpler 'bite sized' portions of the protocol would be covered in session and assigned for at-home practice (e.g., Behavioral Prescriptions). What the patient can tolerate, comprehend, and commit to is the determining factor for how much of each protocol is implemented.
ADAPTING THERAPIES TO PATIENT NEEDS AND ABILITIES
Dr. Freeman assesses new patients to determine their plan of care. In individual session notes, the intervention protocol or device used is referenced.