Brian Pope is a psychotherapist who has worked in many different roles in the NHS, including as a director of nursing services. He has worked in both clinical and managerial roles in psychiatry, as well as being a nurse in general medicine specialising primarily in cardiology. His work focuses largely on biofeedback techniques, exploring how our nervous system is impacted by stress, and how practical steps using modern technology can help.
Knowing little on biofeedback therapy, I became curious to understand how it all worked. The following interview was borne out of that curiosity, and includes insight into Brian’s influences and work in the NHS.
What were the main influences drawing you to mental health work? Are they the same influences which keep you in the field today?
I was always fascinated by the relationship between the brain and the body and I can remember in the early days trying to understand the distinction between functional and organic psychiatry. I was bemused that medicine focused on the separation between different parts of the body. This influence came to a peak for me, much later, when working with a trauma client, who had five specialists working with him focused on specific aspects of his body and it was virtually impossible to get consensus on how to proceed in the clients best interest.
This tension moved forward for me when I worked with a client who presented as an acute anxiety state with a complex grief reaction. It became clear that she also had Takusubo’s Syndrome, a dilated left ventricle. Working with cardiology support we used conventional psychotherapy techniques and her anxiety state gradually resolved. Her left ventricle gradually returned to normal with no conventional medical intervention. This clarified for me that there is a direct relationship between our psychological and physical experience and this understanding has been my main influence over the past few years.
You write that you have researched “how our nervous system is impacted by stress and how practical steps using modern technology can help us…” – which methods stand out to you as being particularly helpful and why?
Following on from working with the lady with Takusubo’s Syndrome, I gradually started exploring techniques that could help my clients further. It became clear that biofeedback techniques could provide insight from a sub conscious perspective that could help people understand more objectively what was happening in their experience and to provide direct feedback on the effectiveness of techniques that they were using to understand if they were effective.
I focused initially on heart rate variability monitoring. There is an extensive research literature showing that good heart rate variability is strongly correlated with good health and that poor heart rate variability is strongly correlated with poor psychological and physical health including anxiety, depression, heart disease, respiratory disease etc. My clients have found this extremely beneficial as it reduces dependence on medication and gives them an objective tool to assess their subconscious experience. I have many case studies where this has worked effectively, for example a lady diagnosed with asthma, and on the verge of being diagnosed with chronic fatigue syndrome was able to make remarkable progress, come off her asthma medication, and make substantial adjustments to her life which improved her health and wellbeing from both objective measurement and self report measures.
For someone who has never heard of biofeedback techniques, how would you explain them?
When we look at ourselves we are doing this from a primarily conscious perspective and we can be completely unaware of the subconscious processes that are operating within us. Biofeedback techniques enable us to look at these aspects and potentially begin to interact with them in ways that can be beneficial for our health. One type of biofeedback is heart rate variability monitoring. This starts from the observation that our heart beat is not regular. It is constantly adapting to the influence of the autonomic nervous system and other factors which is adjusting our system in response to conscious and subconsciously perceived threat.
We can see this influence by using the example of going into a coffee shop and the ways that we experience that. If my system is balanced I tend to experience being relaxed, enjoying my surroundings and the people that I may be with. My thoughts would have particular patterns and my emotion may be positive or neutral.
If I feel threatened for whatever reason my sympathetic nervous system is probably elevated. This leads to a completely different experience I’m on edge I may have a range of reactions such as a startle reaction, i.e. jumpy, on edge, my emotional tone is likely to be negative along with my thought patterns.
With heart rate variability monitoring it is possible to identify which of these patterns I’m in. The autonomic nervous state that we are in may be appropriate i.e. there may be a threat but often with chronic stress levels we are decoupled from the world around us and we are not accurately perceiving and responding to threat. There are major long term consequences for our health if this becomes prolonged.
When working for the NHS, what did you notice about the general perceptions and approaches towards mental health?
My primary perception of the NHS is the incredible separation between bodies and minds and this still seems to persist today. Much of my early career was involved in the Care in the Community initiative and the closure of large psychiatric hospitals. The return of people to local populations was strongly resisted in many areas including Primary Care and local hospitals as well as local communities. This still seems to persist in many areas where mental health problems are perceived as a weakness.
You have mentioned that you became frustrated with the constraints of the NHS – which constraints in particular had that effect on you?
My primary frustration was the politicisation of the NHS and the difficulties in achieving change. There was also considerable resistance to change. For example, in the late 90’s it was obvious that Health and Social Care in psychiatry could provide a more effective service if they were integrated and we achieved this with clearly improved outcomes. Thirty years later, there are still organisational territory issues between Health and Social Care.
Being a CBT practitioner, how do you perceive other common modalities such as psychodynamic and existential therapy?
My perception has changed substantially over the past ten years. For me now, the primary issue is the relationship between the conscious and sub conscious aspects of our experience. Being able to obtain accurate feedback on internal changes shifts the dynamic away from the therapeutic modality onto what works for the client. For example, I see many people where they have been advised to take deep breaths and develop mindfulness approaches. I’m very cautious about this kind of recommendation. Different people respond in different ways to the same instruction and without some objective feedback on the results it’s very difficult to know if a particular approach is helping or not.
If you want to learn more about Brian’s work and read more to do with biofeedback therapy, check out the links below.
Brian Pope’s LinkedIn: https://www.linkedin.com/in/brianjpope/?originalSubdomain=uk
Mayo Clinic on Biofeedback Therapy: https://www.mayoclinic.org/tests-procedures/biofeedback/about/pac-20384664
Biofeedback in medicine: who, when, why and how?: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2939454/
What is biofeedback therapy and who can benefit?: https://www.medicalnewstoday.com/articles/265802