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The manner in which biofeedback is offered should mirrorthat of the patient’s current phase of treatment. Typically,when patients first arrive to Sierra Tucson, they are highlyactivated or overwhelmed. As they settle into rehab,patients become more grounded and begin to becomemindful of their issues and triggers. As the weeks progress,patients metamorphose into having resolve and clarity andare prepared to move on to the next phase of their recoverytrajectory upon discharge. Our R4 Model of Recovery wasdevised to coincide with this typical healing process.The four ‘‘Rs’’ represent (a) rehabilitation, (b) reintegration,(c) rehabituation, and (d) resiliency. It is a flexiblesystem, embodying the cumulative process of biofeedbacktraining over time. This program is designed to flex withsymptom severity, patient need, time until discharge, andpractitioner availability. Although we rely on publishedstudies to guide our protocols, we may not necessarilyfollow all protocols to a ‘‘T,’’ because we may receivepatients at varying times during their rehab process. Thus,it is necessary to meet patients at their level of progress (ordistress) and to tailor protocols that are best suited tocontribute to overall improvement.
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