Rebecca Andrews is not her real name. Today at 30, she is a highly placed professional in a high-tech field. But neither her co-workers nor her employers, she fears, would look kindly on a rebellious adolescence that included several years of abusing drugs, sometimes prescribed, sometimes illegal.
She and her husband recently started a family, which speaks more to the success of her rehabilitation than almost anything else. Except, perhaps, how good she feels about herself.
Rebecca Andrews is a diabetic--the so-called Type I, insulin-dependent. And everyone who has been a part of her treatment in the past decade or so agrees that biofeedback therapy played a significant role in her transformation.
She was diagnosed when she was 13, and during the four succeeding years was hospitalized almost bimonthly because of the instability of her illness. She also faced a series of life crises during that period that would have posed problems for any teen-ager--the breakup of her parents' marriage, her alienation from her family . . . depression . . . suicide attempts . . .
By the end of her teens she was already showing signs of one of diabetes' most fearsome complications: retinopathy, an eye disorder that makes diabetes the leading cause of new blindness in this country.
The impact of emotions on diabetes was described 300 years ago, but only in the past couple of decades have researchers been able to demonstrate the links between emotional stress and an ever-growing list of physiological disorders, including hormonal-imbalance illnesses like diabetes.
For a lot of people (and doctors) the very name "biofeedback" still gives rise to thoughts of gimmickry. Even the scientists who extol its virtues wish it had a name less evocative of (totally unrelated) things like astrological biorhythms.
Biofeedback is simply a device for translating some internal biological signals into clicks, beeps or electronic readouts that can be perceived by the patient experiencing them.
In the simplest sense, the individual begins to sense when his muscles are tense and--with the feedback reflecting his progress--can learn to relax them.
Biofeedback has been dramatically useful in controlling headaches, especially tension and migraine, and in helping control hypertension.
Early on, researchers discovered that the body's stress hormones--including the catecholamines (the "fight-or-flight" hormones such as adrenalin) and others--appeared decreased in individuals able to relax into levels of very low muscle tension.
The hormones are intricately related to levels of blood sugar--the fluctuation of which is the common denominator of diabetic symptoms. Indeed, biofeedback researchers found that in certain individuals, blood sugar dropped low enough to produce insulin reactions (whether by increasing insulin or triggering more efficient use is still unclear). What actually causes diabetes is still a mystery, but its complexities are being resolved more and more.
One of the pioneers in biofeedback therapy, and in its application to diabetes, is Lilian Rosenbaum, a Ph.D. clinical associate professor and director of the biofeedback program at the Georgetown University Family Center. Her work has been to integrate biofeedback as a tool in the center's notable family-systems approach to psychotherapy, and her studies have demonstrated that biofeedback is more effective used with family therapy than alone.
Says Rosenbaum, "One of the basic assumptions I make is that under actual or perceived stress, there is a change in arousal. This has a variety of consequences in autonomic and endocrine function . . .
"Biofeedback," she says, "can help . . . to decrease over-reaction or even help the individual prevent that whole response to stress ."
Rebecca Andrews came to the center because of the drug problem and the depression. Not because of the diabetes. She came for the family therapy. Not for the biofeedback. It was one of those scientific serendipities.
One day she suggested to Rosenbaum that maybe she--Rebecca--might like to try biofeedback.
That treatment, acknowledges Rosenbaum, had some ethical problems associated with it at the outset.
"It is really a double bind with diabetics," she says, "because of the possibility of severe fluctuations of hypo- and hyperglycemic events. When you tell a diabetic to relax, it's really terrific if it works because it can lead to better control." But there is always the risk of a potentially dangerous insulin reaction.
It was at least partly because of this risk that virtually no research had been done on the matter. (There is more going on now, in the wake of Rosenbaum's work with diabetics over the past few years.)
Rosenbaum reasoned, however, "that to eliminate a diabetic from the potential of biofeedback and self-regulation, because he or she was a diabetic was unfair."
Rebecca Andrews, confident and smiling, eyes clear, stood a while ago before an audience of biofeedback therapists--psychiatrists, psychologists, neurologists--and talked about her own experience.
She talked about the alienation of the teen-age diabetic, "just when you don't want to be different. It's really very, very difficult when you go to parties and you can't eat what everyone else is eating. I was afraid to tell my friends, and when I did they'd say cheerful things like, 'Oh my grandmother died from that . . .' "
Several times, she said, as she began to relax during biofeedback sessions she could feel that she might be slipping into an insulin reaction. After that she always brought a can of orange juice or a Coke to her sessions. "I checked with the Joslin the world-famous diabetes center in Boston and I began to treat the sessions the way diabetics approach vigorous exercise--by taking a little extra carbohydrate."
Of her recovery and newfound stability she says now:
"I can't say scientifically that biofeedback was it, but I can't say it had nothing to do with it either."
Rebecca returns periodically to the center to test herself against the equipment. She continues to be free of drugs, of the stress symptoms that provoked them and manages her condition better now on lower insulin doses.
Rosenbaum began seeing other diabetics and began to document improvements--some more dramatic than others. One woman, who had had one tragic pregnancy ending in a stillbirth, credits biofeedback with helping her withstand the special stresses of diabetes and pregnancy. Her healthy child is now nearly 2 years old.
"One of the main things," Rosenbaum feels she has established "is that there were no negative complications related to biofeedback."
She has presented a number of papers on her work, although she points out that her initial patients were "self-selected, not ones a researcher would choose for a protocol."
And in the past year, she has begun to work closely with a Washington-area diabetologist, Dr. Robert L. Tanenberg, who also teaches at Georgetown.
He uses a team approach now including Rosenbaum's stress-management program. It is, he says, "a very promising new area, a new tool we can use." This is, he says, a "time of exploding breakthroughs in the treatment of diabetes . . . Stress has been slighted, but more and more we are seeing its importance."
Rosenbaum is the first to say that "I don't want it to sound like just because I saw some patients successfully that I think this works for everybody." She will urge further research when she presents a paper on her work with Dr. Tanenberg at a meeting of the American Diabetes Association later this month.
Meanwhile, she has installed a blood-glucose monitoring device at Georgetown University clinic, and continues her work with Tanenberg's patients. She has also added his team-approach concept to the Family Center's diabetes program, requiring all patients to consult with a diabetologist and nurse-dietician.
Tanenberg and a team of diabetes educators--once part of his office, but now established separately as Diabetes Educational Services, Inc.--teach diabetic patients and healthcare practitioners the latest in research, insulin management, the intricacies of nutritional management, the importance of exercise.
And now, as he puts it, "Lilian helps them get their heads straight."