It has been more than a decade since Sierra Tucson began to integrate biofeedback as a supportive service to augment its therapeutic strategies for patients affected by addiction, trauma and related problems. As the Arizona treatment organization has grown and its payer mix has changed, the challenge of maintaining this research-based approach as a prominent service has intensified.
“We have been up against managed care being selective in what it will cover,” Antoinette Giedzinska, PhD, Sierra Tucson's director of applied neuroscience and outcomes, tells Addiction Professional. “In my opinion it is a shame. Insurance companies are still turning a blind eye to it.”
For Giedzinska, a rotation at a Department of Veterans Affairs (VA) program that demonstrated the benefits of biofeedback for pain management illustrated to her how patients can gain control over their stress response. For patients with addictions, this can serve as an important strategy for limiting craving. Sierra Tucson uses in its programming medical-grade NeXus technology that can accurately read a patient's heart rate, brain activity and other functions.
Giedzinska says patients with substance use disorders, a group for whom biofeedback and related techniques have been seen as underutilized, appreciate the benefits of these mind-body interventions. They come to realize, “I can get to this pleasant state without substances,” she says. “They have the 'a-ha.'”
Now a group approach
Giedzinska introduced biofeedback to Sierra Tucson's programming in 2009. When the facility's census hovered around 75 and most patients were self-pay, she and one other staff member could conduct individual sessions for the patient population. Today, with double that census and more patients under insurance arrangements, group sessions have become the norm.
Giedzinska describes the organization's current application of these techniques as a combination of biofeedback and neuromodulation. With insurance coverage for these practices limited, Sierra Tucson is charging patients for the services, but is packaging them less expensively than what they would cost at a community clinic or in a private practice, she says.
Some of Sierra Tucson's protocols include a sleep enhancement lab (Giedzinska calls sleep difficulties an “unspoken issue” for patients with addictions) and a “calm” lab that trains patients to turn off the active mind naturally, providing an introduction to meditation practices.
Ideally, daily training in biofeedback and neuromodulation would be welcomed, but with an already rigorous patient schedule, a frequency of two sessions a week with practice time outside of the sessions is the goal, Giedzinska says.
All of these practices “accelerate the benefits of therapy,” she says. Many patients upon leaving treatment will purchase a device for their post-treatment use or will seek to connect to a provider in the community.
Giedzinska has taken courses from the Biofeedback Certification International Alliance, the nonprofit credentialing authority for practitioners in this area, and says her organization seeks to work with professionals who have met the alliance's certification requirements.
The organization often needs to tailor its approach to particular health concerns of the patient, she says. A patient who is light sensitive or who suffers from migraines may not be able to engage in neuromodulation techniques that tap into aspects of sight and sound, but could do better with traditional biofeedback, she says. Also, she says patients with severe obsessive-compulsive disorder may struggle too much with reaching perfection in controlling their stress responses, she says.