Why the Nijmegen Questionnaire should be part of the neurofeedback workup.

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Here is a list of 16 common and disturbing symptoms that are tracked by this questionnaire. The score on the questionnaire (i.e., above 23) establshes the likelihood that these problems can be significantly ameliorated by breath training (e.g., HRV).

AnxietyConfusion or loss of touch with realityPalpitations in the chestChest painFeeling tenseBlurred visionDizzinessStiffness or cramping in fingers or handsFast or deep breathingShortness of breathTightness across chestBloated sensation in stomach areaTingling in fingers or handsDifficulty in breathing or taking a deep breathTightness around the mouthColdness of hands and/or feet

If your neurofeedback training causes the client to re-experience implicit memories, alter autonomic tone, social-engagement, posture or vagal ventilation-perfusion dynamics, you can have a disturbing increases in these 16 symptoms during training. What do you do then?

Neurofeedback practitioners without clinical licenses may be facing legislative crises in several states in large part due to the fact that when these symptoms re-appear or worsen during sessions, the trainer does not understand the significance. At such times, the worst thing to do is to blame the client, or the protocol, or abandon the client to another practitioner. Such actions re-traumatize the client, worsen disorganized attachment systems, and promote dissociation.

Here is an abstract that indicates that the 16 symptoms in the Nijmegen questionnaire can be significantly ammeliorated by breath training, especially with respect to lowering the breathing frequency (HRV training). The appearance of such symptoms during your sessions with your clients is a gift! You can work with it. The strong connection between EEG and HRV will give you an advantage other practitioners don't have.

Han JN, et al (1996). Influence of breathing therapy on complaints, anxiety and breathing pattern in patients with hyperventilation syndrome and anxiety disorders. J Psychosom Res. 1996 Nov;41(5):481-93.

The effect of breathing therapy was evaluated in patients with hyperventilation syndrome (HVS). The diagnosis of HVS was based on the presence of several suggestive complaints occurring in the context of stress, and reproduced by voluntary hyperventilation. Organic diseases as a cause of the symptoms were excluded. Most of these patients met the criteria for an anxiety disorder. The therapy was conducted in the following sequence: (1) brief, voluntary hyperventilation to reproduce the complaints in daily life: (2) reattribution of the cause of the symptoms to hyperventilation: (3) explaining the rationale of therapy-reduction of hyperventilation by acquiring an abdominal breathing pattern, with slowing down of expiration: and (4) breathing retraining for 2 to 3 months by a physiotherapist. After breathing therapy, the sum scores of the Nijmegen Questionnaire were markedly reduced. Improvements were registered in 10 of the 16 complaints of the questionnaire. The level of anxiety evaluated by means of the State-Trait Anxiety Inventory (STAI) decreased slightly. The breathing pattern was modified significantly after breathing retraining. Mean values of inspiration and expiration time and tidal volume increased, but end-tidal CO2 concentration (FETCO2) was not significantly modified except in the group of younger women (< or = 28 years). A canonical correlation analysis relating the changes of the various complaints to the modifications of breathing variables showed that the improvement of the complaints was correlated mainly with the slowing down of breathing frequency. The favorable influence of breathing retraining on complaints thus appeared to be a consequence of its influence primarily on breathing frequency, rather than on FETCO2.

My apologies for my previous mispelling of Nijmegen (I type fast but, unfortunately, phonetically). You may have wanted to do an internet search. Incidentally, there are many more references available through a search than through pubmed.gov.

This additional post is also partly in response to the individuals who back channeled me for a copy of the questionnaire.

Best wishes,

Dailey, L.Ac., BCIAC, BCIA-EEGwww.growing.com/mindmind@...