Integrative Pediatric and Adolescent Health: Educational Web Column

October 2008: Self-Regulation:
What you already know that you didn't know you knew,
and ways to get better at it

Self-Regulation as a technique for managing stress
Self-regulation is a skill we all use to balance tension or stress in our bodies and minds. We do this in a number of ways, most of the time without thinking about it. Have you ever noticed yourself taking a deep breath or sigh immediately after a near miss on the road? At a stoplight, say, just as the light turns green and you start to go a car zips by right in front of you, running the red light. You feel a sudden shock of the near miss and within a few moments realize that you’re OK and can proceed. At some point in those moments is a deep sigh or breath, blowing out air through your mouth or saying ‘whew.’ That is a moment of self-regulation. An unconscious but necessary re-setting of your acute stress response back to (or at least closer to) your normal level of alertness. Making this a more conscious act is what learning a mind-body skill does.

Stress has been clearly linked to the state of our health, and the health of our families. Whether the result of an acute stressful event, or the accumulation of multiple stressors, if we do not have a way to reset our stress level, the effects build up and impact us. We can mitigate these effects by…

Reducing the amount or type of stresses in our lives (like taking a week off from TV or radio news programs).
Getting enough physical exercise.
Eating well.
Learning a self-regulation skill such as simple diaphragmatic breathing, guided imagery, biofeedback, mindfulness meditation, and others.

Learning one or more of these skills can help children and adolescents (and their parents) identify their innate ability to balance stress, and cultivate their desired level of health and wellness. To some degree self-regulation is innate. If a child’s temperament and innate self-regulation skills match well, they may naturally regulate their bodies without consciously realizing it. On the other hand, if there is a mismatch in temperament or if the innate skills are overwhelmed, learning a new skill can be very helpful.

For Infants
Infants naturally calm themselves by sucking. One of the first things a new parent can do in the nursery with a fussy infant is give the baby their finger to suckle on. Breastfeeding, of course, is the most important thing to learn, but Mom's need a break from this from time to time. When infants are close to 6 months of age, a parent can teach them to find their own thumb to help calm themselves to sleep, at middle of the night awakening, or other periods of stress.

For Toddlers to Elementary School-Aged Children
Toddlers often still rely on thumb sucking. They also have the capacity to calm themselves simply by daydreaming or becoming entranced in the world around them. For preschool and elementary school children, telling stories and adjusting the tone and content by the storyteller, can have a similar effect. By about 5 or 6 years of age, children can be taught how to use their imagination as a way to change the physiology of their bodies. Guided imagery, self-hypnosis, biofeedback and simple breathing techniques can all be used to great effect for children in many circumstances (see table).

Therapeutic applications of self-regulation techniques
Anxiety	Migraine
Asthma	Painful procedures
Attention problems	Pruritis
Chronic/Recurrent Pain	Sleep problems
Enuresis, Encopresis	Sports performance
Habit problems	Tics and Tourette syndrome
Irritable bowel syndrome	Warts

What are these techniques and are they common?
Guided imagery and simple relaxation or breathing practices have a general acceptance among the public. But there are wide misconceptions about hypnosis. As defined by Dr. Karen Olness, a pediatrician at Rainbow Babies and Children’s Hospitals and leader in self-regulation training…

Hypnosis is a state of awareness, often but not always associated with relaxation, during which the participant can give him- or herself suggestions for desired changes to which he or she is more likely to respond than when in the usual state of awareness. Spontaneous self-hypnosis may happen while reading, listening to music, watching television, jogging, dancing, playing a musical instrument, doing tai chi, doing yoga, or performing similar activities.

The clinical practice of hypnosis, despite its depiction in movies and stage shows, has nothing to do with the control of the learner. On the contrary, the patient is always in control, is never ‘asleep,’ and needs to practice consistently for the new skill to have the desired physiologic effect.

Hypnosis and guided imagery are a lot alike. Another way of describing both techniques is learning how to use your imagination to help focus your mind in a way that positively affects your body.

Biofeedback involves the use of a computer or device that turns the body’s signals (heart rate, muscle tension, brain waves) into a graphic picture or game. This can be as simple as a small sticker that changes color with the temperature of your skin. Some programs are available on the internet and can be used without any training. In my experience, the best benefit comes from learning how to use these programs with a trained practitioner who can guide you through this process and help you understand what the biofeedback images mean, and how to recognize how stress is impacting your body. With practice, and often the concurrent use of imagery, hypnosis or breathing practices, the learner develops a stronger awareness of the connection of mind and physiologic changes in the body and how to control them.

For Adolescents and Adults
In addition to the techniques described above, adolescents and adults can also learn mindfulness meditation practice. From the Osher Center web site, “Mindfulness is the practice of paying attention from moment to moment in a non-judgmental way. This simple, but powerful practice opens the door to self-healing and insight. It can also provide options for coping with the stress of everyday life and the stress of illness.” Mindfulness classes are available throughout the Bay Area, and are even becoming more common in elementary, middle and high school curricula (see the Mindfulness in Education Network).

One of the advantages that mind-body skills have over most of the therapeutic treatments of western medicine, or many other systems of medicine, is the shift from an external to an internal locus-of-control. What this means is that instead of depending upon a pill or a procedure, a skill can be learned that you take with you, every day, to either accomplish the same thing, or augment the effect of necessary medical treatments. I encourage you to explore these techniques yourself as well as with your children and family members.

Resources and Research Links

Hypnosis
Hypnosis for eczema
Hypnosis for irritable bowel syndrome
A wonderful summary of the use of self-hypnosis with children, including reviews of the evidence can be found here.

Biofeedback
Journey to the Wild Divine
HeartMath

Guided Imagery
Academy for Guided Imagery

Mindfulness and Meditation
UCSF Osher Center for Integrative Medicine programs in mindfulness practice
Mindfulness effects on the brain and immune system
Mindfulness in Education Network

Other practices
Somatic experiencing

About the Column

This column presents an integrative medicine view on a range of topics relevant to children, teens and early adolescents including: nutrition, herbs & supplements, mind-body and self-regulation skills, and general health and wellness.

If you’re new to the concept of integrative medicine, take a few minutes to browse the UCSF Osher Center web site, particularly the page what is integrative medicine?

Broadly speaking, integrative medicine is practicing good medicine. It is an approach to a child’s health that:

places illness in the context of the child, rather than the child in the context of illness;
takes into account family and environmental factors;
neither rejects conventional medicine nor accepts complementary or alternative medicine (CAM) uncritically.

Integrative pediatric consultations are available at the Osher Center with Kevin Barrows, MD, Rick McKinney, MD, and Priscilla Abercrombie, RN, NP, PhD, AHN-BC. To make an appointment, please call the main clinic line at 415.353.7720.

David Becker, MD, MPH is an Assistant Clinical Professor in the Department of Pediatrics at the University of California, San Francisco, and Affiliate Faculty at the Osher Center for Integrative Medicine at UCSF. He is starting the Pediatric Integrative Pain Clinic in July 2008. This is a referral-based service for children and adolescents with chronic pain. For questions about referrals, please contact the main Mt. Zion Pediatric number: 415.885.7478.

In addition, we offer two healthy parenting stress reduction classes: Mind in Labor and Mindfulness-Based Childbirth and Parenting.

Integrative Pediatric and Adolescent Health: Educational Web Column

October 2008: Self-Regulation: What you already know that you didn't know you knew, and ways to get better at it

October 2008: Self-Regulation:
What you already know that you didn't know you knew,
and ways to get better at it