Cognitive-behavioral treatment with biofeedback-assisted exposure in a patient with idiopathic environmental intolerance attributed to electromagnetic fields (IEI-EMF)

Abstract

Objective: Idiopathic environmental intolerance attributed to electromagnetic fields (IEI-EMF) is a poorly understood chronic condition, characterized by reports of various non-specific physical symptoms when an EMF source is present or perceived by the individual. IEI-EMF is associated with increased illness behavior and severe physical, social and professional disabilities. Epidemiological and provocation studies found no proof for EMF as causal agent, whereas increasing evidence suggests an important role for psychological processes such as nocebo-effect and attribution. Research on treatment options is still in its infancy. The best evidence currently available suggests that cognitive-behavioral therapy is most appropriate. However, more treatment studies are urgently needed. Design: Single-case pre-post AB design Setting: Comprehensive behavioral treatment package (14 one-hour sessions) including psychoeducation, elements of Acceptance and Commitment Therapy, and biofeedback-assisted exposure in vivo in an outpatient treatment center specialized in medically unexplained physical symptoms. Participant: 62 year old female with IEI-EMF. Medical tests excluded underlying organic pathology. Various physical complaints present since 2 years: dizziness, skin rash, memory and concentration problems, sleeping problems, fatigue, dry mouth, chest pain, stomach ache and palpitations, with as main complaint a sharp, stabbing pain in the head. Patient suffers from severe social, professional, physical and financial impairment. Main Outcome Measure(s): Pre-post measures of the Dutch version of the SCL-90, AAQ-II and physiological parameters (PetCO2, respiration, skin conductance, sEMG, peripheral skin temperature, heart rate, heart rate variability). Physical complaints, avoidance behavior and subjective well-being were also questioned. We looked at clinical significance and reliable change index. A randomisation test was used to evaluate the effect of the treatment on the main complaint of stabbing pain in the head, which was measured repeatedly over time. Results/Conclusions: Results show a reliable change in acceptance, subjective well-being, and reduced avoidance behavior. A pre-post treatment effect was observed for stabbing headache, as well as for all physiological parameters, showing recovery of the autonomous nervous system. A reliable change and clinically significant decrease were observed for the total SCL-90 score, as well as for the subscales of Somatic Symptoms, Inadequacy of thinking and acting, and Sleeping problems. Attribution towards environmental factors was reduced, yet not completely absent after treatment. Overall, this single-case study may serve as a good example of the scientist-practitioner model and contributes to our knowledge of treatment options for IEI-EMF.