”If you only have a hammer, you are looking for a nail, but if you have a toolbox, you can learn to learn / train yourself to use it in a tailor-made customized way that benefits you!”
Praeludium: I think most people know that blood pressure vary between individuals but perhaps some do not understand that i vary within individuals over situation/emotions and time! Something which have consequences for examinations and interventions. To measure 1-2 times at clinical offices also after 15 minutes rest says mostly very little if anything about individuals in real life. Also 24h measure do not show real (reasonable functional) dynamics of an individual´s blood pressure BEHAVIORS! So, we present more real word close ways, where we also test how individuals` themselves can control/influence/change their blood pressure, giving information about HOW THEY CAN further develop their not know skills. We have seen hundreds of patients during the years happily begin to tailor (in group workshops) their tools, where the only (so far) side effect can be fainting if they proceed with pharmacological substances as they have done. Pharmacological substances may prevent normal dynamics but can (after serious examination consideration) be use as ”swimming pads” (if not really life treating). Our critics below (as well as recommendations) are not targeting individual clinicians but the basic school medicine/pharma reductionism paradigm and its questionable number of consequences including education and training!
NB very much working text – be careful if reading!
From hypertension material 2012 updated
Are IPBM* certified psychologists the ones who can significantly most effectively investigate and intervene in the field of hypertension?
*Integrated Psychophysiological Behavioural Medicine (www.ipbm.se – Swedish text!) with the manual ”the patient as reasonably competently trained resource and co-worker in his own rehab” (manual further developed from part of Prof Bo von Scheele’s doctoral thesis in 1986)
The below text might be seen as promoting our model, but that’s not really the main intention below – but:
The main intentions are:
to diskuss/demonstrate the benefits of IPBM over (especially routine) drug use, In this case it concerns high blood pressure!
* That integrated clinical psychophysiology offers tools and instruments that are crucial for effective blood pressure care – unfortunately, the area is not known or relatively unknown in Sweden
* That our method constitutes an unusual variant in international clinical psychophysiology, as it is adapted to Swedish health care but also based on popular education pedagogy (von Schéele was originally a folk high school teacher)
* That the method is likely to be most effectively used by psychologists (time-wise as well as behavioral knowledge / practice base) who certify themselves via internet workshops** while working full time, having family and leisure time. ** Adds priority puzzle pieces to a puzzle in seriously flexible individual best way.
* IPBM enables intertwining of spatial (the language of the limbic part of the brain) and verbal (”modern” homo sapiens language) communication that is often crucial for consciously planning for strategy clusters that affect non-conscious processes (via the limbic system, which can e.g. affect the autonomic nervous system (especially important for affect the systolic part of our blood pressure is the sympathetic part) while being able to SEE the effect of what one does (on- or–off-line), i.e. whether you succeed or not! Can thus search for the individual most optimal strategy cluster.
Abbreviations below
- Interventions = altering influences with the intention of normalizing identified dysfunction/disorder
- IPBM = Integrated Psychophysiological Behavior Medicine
- ACE = ” ACE inhibitors are drugs that lower blood pressure by inhibiting the enzyme angiotensin converting enzyme (ACE). In inhibition of ACE, the breakdown of angiotensin I to angiotensin II that occurs in the vascular wall of the body’s blood vessels decreases.” https://sv.wikipedia.org/wiki/ACE-h%C3%A4mmare
- Ideographic = Clinical: Individual level, also single case design
- Nomotetic = Science: normative, generic level
Introduction
This is perhaps quite much complex but crucial to understanding what is then discussed below
”If the only tool you have is a hammer, you will start treating all your problems like a nail.” https://www.commscope.com/blog/2015/if-your-only-tool-is-a-hammer/#:~:text=There%20is%20an%20old%20saying,a%20pounding.%22%20Abraham%20Maslow%20modified Do we start from the mantra that treatment (by and large) is medicines Do we have medicines , something that can not only be seen as rationally conscious but also also habitual paradigmatic Limbic memory consolidated, unconscious, underlying mindset, given not as well as Thales principle (Confirmation bias and… | Cultural Medicine) critically examines itself as well as asks others (seriously) to examine critically us, so that together we can increase our knowledge, well aware that we do not have access to absolute knowledge with more or less well-developed paradigms
Comparison 1:
Comparison 1: First, a brief about comparison between blood pressure and watering with hose in the garden. In both cases we have
(a) The blood pump/tap that regulates the flow including quantity/frequency and power/contraction. Drugs try to artificially, externally reduce when stress temporarily – chronically is overactivated automatically (autonomic nervous system) while with the IPBM method (and the like) you learn to regulate the autonomic nervous system itself which gradually becomes habitual (automatically limbically controlled) activity. Thus, via our own internal biology, we learn and then self-care / train so our biological systems manage blood pressure so it works dynamically normally – which we can measure via e.g. the cStress FT measurement system cStress FT | Stress medicine
(b) A Tube/hose/pipe that is more or less elastic/flexible, can be expanded if necessary. The diameter is important for the characteristic functional needs of water and blood flow where biopsychosocial stress in modern man evolutionarily non-functionally contracts (constriction) above all the capillary blood vessels when the sympathetic nervous system is activated (for nowadays not entirely current struggle and / or flight), which, especially over time (chronic, not always something we are aware of but habitually adapted to).
Drugs try to artificially, externally increase the diameter of blood vessels (whether they are constricted or not, since it occurs statically while with the IPBM method (and the like) one learns to self-regulate the sympathetic (part of the autonomic) nervous system that gradually becomes habitual (automatically limbically controlled) activity. Thus, via our own internal biology, we learn and then self-care / train so our biological systems manage blood pressure so it works dynamically normally – which we can measure via e.g. the cStress FT measurement system cStress FT | Stress medicine
(c) What flows through the tube/blood vessel may have different consistency and density as well as more or less harmful substances/substances.
Drugs try to artificially, externally influence certain specifically addressed substances (not always via investigation if necessary) affect the (not infrequently presumed) content of the blood, but that this happens statically, the result is not dynamically adapted, which is one of the problems with artificial external influence. Whereas with the IPBM method (and the like) you learn to influence the properties of blood yourself via learning current (and trying to wisely sort among everyone who talks about what is best in an increasingly complex information mess) reasonable knowledge of diet where you try yourself as well as other tools, e.g. individualized exercise and biologically individually correct breathing behavior (the central role of metabolism!) etc.. Thus, via our own internal biology, we learn and then self-care / train so our biological systems take care of the blood’s properties so that it (as well as also when blood pressure) works dynamically normally – which we can measure via e.g. the cStress FT measurement system cStress FT | Stress medicine
Comparison 2:
Then Focus below on comparing drug method and IPBM method, especially biological (system, mechanism function, risks and safety and practical clinical use). Uses metaphor method = Compare high blood pressure with spraying water in a hose with high pressure – same principle but perhaps a little more demanding to get your blood pressure in order
Table: Blood pressure behavior influence of drugs vs IPBMs method
What Focus Drugs IPBM
Blood Pump Frequency-Contraction Bisoprool et al. (a)See (a) See (a)
Tube/vessel Diameter/flexibility/inflame ACE inhibitors (b)+ See (b) See (b)
Fluid/blood Flexibility & content characteristics Statins et al.( c) See( c) See ( c)
Consequences Risks vs no known ones See (d) See (d) See (d)
In short; the pressure in the blood vessels as well as in the water tube depends on (a) Frequency contraction, ie how fast / vigorously the ”blood pump” works (normally during physical exertion ,but not during biopsychosocial stress reactions when we do not fight / flee for survival stress reasons. (b) Diameter/flexibility/inflammation, in case of stress, especially superficial blood vessels contract and in chronic stress they become less flexible as well as inflammation-prone (c) Buoyancy & content properties, i.e. normal or viscous and with destructive content’s impact on the blood vessel walls, etc. – which has (d) consequences partly on blood pressure itself but also on complex dependence and actually also indirectly independent systems (very poorly understood where subjective reports say little if anything about the dysfunction development of mechanisms), which together can develop more complex chronic, at worst life-threatening chronic dysfunctions! Hence the term ”silent killer” because often high blood pressure does not always produce non-silent symptoms!
(a) The beating force and speed of the blood pump (heart)
Features:
Function of beta-blockers: E.g. Bisoprolol*: ”Beta-blockers also lower blood pressure via several mechanisms, including decreased renin and decreased cardiac output. The negative chronotropic and inotropic effects lead to a decrease in oxygen consumption; this is how angina improves after beta-blocker use.” https://www.ncbi.nlm.nih.gov/books/NBK532906/#:~:text=Beta%2Dblockers%20also%20decrease%20blood,improves%20after%20beta%2Dblocker%20usage.
* ”Bisoprolol belongs to a group of drugs called beta-blockers. https://www.fass.se/LIF/product?userType=0&nplId=20080329000039
”Bisoprolol prevents irregular heart rhythm (arrhythmia) during stress and reduces the workload of the cardiovascular system. Bisoprolol also facilitates blood flow by dilating blood vessels.” https://www.apotekhjartat.se/produkt/bisoprolol-teva-tablett-125mg-blister-20tabletter/
IPBM’s function = lowers blood pressure by using individually designed self-care reinforcement of after investigation individually designed self-care programs and, if necessary integrated biofeedback guidance in the laboratory) autonomic nervous system oscillation and especially down regulates the sympathetic nervous system (which is highest in the dynamic stress biological hierarchy (crucial for effective functional regulation of biological stress, in biopsychosocial stress.
Clinical examination of each individual’s needs before clinicians suggest intervention
Beta blockers usually none at all
IPBM thorough individual dynamic psychophysiological investigation (which also shows the individual patient’s own capacity to influence observed dysfunction which can then be proposed further developed via self-training) in addition to other investigation instruments.
Side effects:
Beta blockers can cause some side effects/symptoms https://www.heartandstroke.ca/heart-disease/treatments/medications/beta-blockers Dizziness, lightheadedness, fainting Sensation Drowsiness or fatigue Unusual swelling of the feet and ankles. Difficulty breathing, etc. Depression Nightmares Cold hands and feet Decreased sexual performance
IPBM causes no known side effects, given properly learned method use by certified clinics
(b) Their behavior, diameter and elasticity
Functions:
Then Focus below on comparing drug method and IPBM method, especially biological (system, mechanism function, risks and safety and practical clinical use). Uses metaphor method = Compare high blood pressure with spraying water in a hose with high pressure – same principle but perhaps a little more demanding to get your blood pressure in order
Table: Blood pressure behavior influence of drugs vs IPBMs method
What Focus Drugs IPBM
Blood Pump Frequency-Contraction Bisoprool et al. (a) See (a) See (a)
Tube/vessel Diameter/flexibility/inflame ACE inhibitors (b)+ See (b) See (b)
Fluid/blood Buoyancy & content characteristics Statins et al. ( c) See ( c) See ( c)
Consequences Risks vs no known ones. See (d) See (d) See (d)
In short; the pressure in the blood vessels as well as in the water tube depends on (a) Frequency contraction, ie how fast / vigorously the ”blood pump” works (normally during physical exertion ,but not during biopsychosocial stress reactions when we do not fight / flee for survival stress reasons. (b) Diameter/flexibility/inflammation, in case of stress, especially superficial blood vessels contract and in chronic stress they become less flexible as well as inflammation-prone (c) Buoyancy & content properties, i.e. normal or viscous and with destructive content’s impact on the blood vessel walls, etc. – which has (d) consequences partly on blood pressure itself but also on complex dependence and actually also indirectly independent systems (very poorly understood where subjective reports say little if anything about the dysfunction development of mechanisms), which together can develop more complex chronic, at worst life-threatening chronic dysfunctions! Hence the term ”silent killer” because often high blood pressure does not always produce non-silent symptoms!
(c) Blood content and consistency
Functions:
Drugs (e.g. statins*) affect statically and NOT individual adapted
IPBM uses the ”tools” diet*, exercise, and above individualized breathing method INDIVIDUAL-BASED which drug does NOT, – o
* ”That something as simple as a serving of oatmeal and an avocado a day can lower your cholesterol, is of course a big plus. After all, these are also things that are easy to use and oatmeal you probably have at home most of the time”, https://www.kolesterol1.se/kolesterolsankande/
Clinical examination of each individual’s needs before clinicians suggest intervention
Drugs: See below*
IPBM thorough individual dynamic psychophysiological investigation (which also shows the individual patient’s own capacity to influence observed dysfunction which can then be proposed further developed via self-training) in addition to other investigation instruments. BUT this also includes special questions about possible breathing training, nutrition and exercise activities, etc.
Side effects:
Drugs, such as statins can cause side effects, ” Statins sometimes cause mild stomach problems such as constipation, nausea or stomach pain. The medicines can also affect the liver and therefore the doctor usually takes a blood test before treatment begins, after a period of treatment and if the dose is increased. A few have had sleep problems from statins,” https://www.1177.se/behandling–hjalpmedel/behandling-med-lakemedel/lakemedel-utifran-diagnos/lakemedel-vid-hoga-blodfetter/#:~:text=risk%20f%C3%B6r%20biverkningar.-,Biverkningar%20av%20statiner,har%20f%C3%A5tt%20s%C3%B6mnbesv%C3%A4r%20av%20statiner
IPBM does not cause any known side effects
* Extra ”both and info” from the heart-lung foundation https://www.hjart-lungfonden.se/halsa/riskfaktorer/hogt-kolesterol/behandling-hogt-kolesterol/#:~:text=Nyttig%20och%20n%C3%A4ringsrik%20kost,-Gr%C3%B6nsaker%20och%20frukt&text=Matiga%20gr%C3%B6nsaker%20som%20rotfrukter%20och,halten%20LDL%2Dkolesterol%20i%20blodet
(d) Consequences in summary
If we now resume the temporary metaphor of ”watering the garden” with the behavior of blood pressure, then we see similarities but, of course, great differences. But basically, it’s (a) too much screwed-on power in the water tap that can push the hose away from the faucet, (b) the diameter of the hose that determines how much water can pass out into the garden, and (c) whether it’s water or oil we’re trying to water with. If any readers want to include the water sprinkler, I’ll see if I can involve it – make suggestions here!
As can be seen from the above, there is a big difference between drugs and IPBM (and also other behavioral methods, which are not discussed here because these usually do not include dynamic psychophysiological measurements for investigations, interventions and documentations). At the same time, there is very little at first in IPBM but well on the pharmaceutical side. In principle, it can be said that traditional conventional medicine builds directly and indirectly (via the paradigmatic argumentations of medicine). This means that education in health care basically does not even know about the existence of IPBM (and similar paradigms). At the same time, no one has absolute knowledge as a basis!
Even the most inveterate drug-using clinicians are beginning to understand that one should not start with drugs but with ”Lifestyle-related changes before drugs”, given that the patient is not in an emergency situation. At the same time, it’s not just writing a prescription tag ”walking daily X time” but lifestyle-related changes deserve knowledge-based, practical training by knowledgeable staff! So more emphasis should be placed on this than just a prescription – whether it’s pharmacological substances or walking.
Now that IPBM certified educations have not been able to develop, despite attempts last 40 years, we are now investing in puzzle-piece workshops where you can piece together your own education based on your own conditions despite working full time, having family and leisure time.
One question I have wrestled with for many years is ”can’t you do without psychophysiological methodology and technology and even without drugs normalize your blood pressure – if necessary”?
My (!) answers are (a) Unfortunately not, because we can SEE what we do and do what we SEE, which means, among other things, that we can consciously influence non-conscious systems (e.g. autonomic nervous system), which is critical precisely to succeed – we do not have to be blind and thus drive into the drug-dependent wall. BUT (b) we can no we learned e.g. use cStress FT then let the body become ”our own biological measuring system” AFTER hla time there is a Limbic operant Conditioning that constantly updates the Limbic memory cluster art act (Kelly, 1955) which means that we take over automatically = (i) can both feel mycekt more sensitive temperature changes because cStress FT measures 1/100 C changes that gradually become reconsolidated (Nader & HArdt https://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.1037.8414&rep=rep1&type=pdf in updated Limbic Memory Cluster Outline!
2022-08-16 Bo von Scheele, Bergvik Open Academy for Innovative Medicine Management