What is Biofeedback?

Biofeedback is a learning process in which people are taught to improve their health and performance by observing signals generated by their own bodies. It is scientifically based and validated by research studies and clinical practice.

Overview

The word "biofeedback" was coined to describe laboratory procedures that trained research subjects to alter brain activity, blood pressure, muscle tension, heart rate and other physiological responses often thought to have been beyond voluntary control. Biofeedback-assisted physical changes are accompanied by feelings of relaxation, improved motor control, and often by relief of dysfunctional physical and/or emotional symptoms.

Biofeedback is non-invasive. When used clinically, a therapist attaches sensors or electrodes to the body and these sensors provide a variety of readings--feedback--that is displayed on equipment, usually a meter or a computer, for the patient to see. One commonly used device called the electromyogram (EMG), for example, picks up electrical signals from the muscles. It translates the signals into a form that people can detect, such as a flashing light and/or a beeper, every time muscles become tenser. If one wants to relax tense muscles, one must try to slow down or eliminate the flashing or beeping. People learn to associate sensations from the muscle with actual levels of tension and develop a new, healthy habit of keeping muscles only as tense as is necessary for as long as necessary. After treatment, individuals are then able to repeat this response at will without being attached to the sensors.

Other biological functions, which are commonly measured and used in these ways, are skin temperature, heart rate (EKG, BVP), sweat gland activity (GSR, SC), respiration, and brainwave activity (EEG).

Clinicians rely on electronic biofeedback systems in somewhat the same way that you would rely on a thermometer. Their systems can detect a person's internal bodily functions with far greater sensitivity and accuracy than a person can alone. With this information, patients can learn to make changes so subtle that at first they may not be consciously perceived. This information may be valuable, as both patients and therapists can use it to gauge and direct the progress of treatment.

Studies have shown that we have more control over supposedly involuntary bodily functions than we ever thought possible. Researchers have proved that many individuals can alter their involuntary responses by being "fed back" information either visually or audibly about what is going on in their bodies. As a result, biofeedback can train individuals with techniques for living a healthier life overall - whether one has a medical condition or not.


Origins

In 1961, Neal Miller, an experimental psychologist, suggested that autonomic nervous system responses (for instance, heart rate, blood pressure, gastrointestinal activity, regional blood flow) could be under voluntary control. As a result of his experiments, he showed that such autonomic processes were controllable. This work led to the creation of biofeedback therapy. Other researchers expanded Miller's work. Thereafter, research performed in the 1970s by UCLA researcher Dr. Barry Sterman established that both cats and monkeys could be trained to control their brain wave patterns. Sterman then used his research techniques on human patients with epilepsy, where he was able to reduce seizures by 60% with the use of biofeedback techniques. Throughout the 1970s, other researchers published reports of their use of biofeedback in the treatment of cardiac arrhythmias, headaches, Raynaud's syndrome, and as a tool for teaching deep relaxation. Since the early work of Miller and Sterman, biofeedback has developed into a front-line behavioral treatment for an even wider range of disorders and symptoms.

During biofeedback, special sensors are placed on the body. These sensors measure the bodily function that is causing the patient problem symptoms, such as heart rate, blood pressure, muscle tension (EMG or electromyographic feedback), brain waves (EEC or electroencophalographic feedback), respiration, and body temperature (thermal feedback), and translates the information into a visual and/or audible readout, such as a paper tracing, a light display, or a series of beeps.

While the patient views the instantaneous feedback from the biofeedback monitors, he or she begins to recognize what thoughts, fears, and mental images influence his or her physical reactions. By monitoring this relationship between mind and body, the patient can then use these same thoughts and mental images as subtle cues, as these act as reminders to become deeply relaxed, instead of anxious. These reminders also work to manipulate heart rate, brain wave patterns, body temperature, and other bodily functions. This is achieved through relaxation exercises, mental imagery, and other cognitive therapy techniques.

As the biofeedback response takes place, patients can actually see or hear the results of their efforts instantly through the sensor readout on the biofeedback equipment. Once these techniques are learned and the patient is able to recognize the state of relaxation or visualization necessary to alleviate symptoms, the biofeedback equipment itself is no longer needed. The patient then has a powerful, portable, and self-administered treatment tool to deal with problem symptoms.

Biofeedback that specializes in reading and altering brain waves is sometimes called neurofeedback . The brain produces four distinct types of brain waves-delta, theta, alpha, and beta-that all operate at a different frequency. Delta, the slowest frequency wave, is the brain wave pattern associated with sleep. Beta waves, which occur in a normal, waking state, can range from 12-35 Hz. Problems begin to develop when beta wave averages fall in the low end (under arousal) or the high end (over arousal) of that spectrum. Under arousal might be present in conditions such as depression or attention-deficit disorder, and over arousal may be indicative of an anxiety disorder, obsessive-compulsive disorder, or excessive stress. Beta wave neurofeedback focuses on normalizing that beta wave pattern to an optimum value of around 14 Hz. A second type of neurofeedback, alpha-theta, focuses on developing the more relaxing alpha (8-13 Hz) and theta waves (4-9 Hz) that are usually associated with deep, meditative states, and has been used with some success in substance abuse treatment.

Through brain wave manipulation, neurofeedback can be useful in treating a variety of disorders that are suspected or proven to impact brain wave patterns, such as epilepsy, attention-deficit disorder, migraine headaches, anxiety, depression, traumatic brain injury, and sleep disorders. The equipment used for neurofeedback usually uses a monitor as an output device. The monitor displays specific patterns that the patient attempts to change by producing the appropriate type of brain wave. Or, the monitor may reward the patient for producing the appropriate brain wave by producing a positive reinforcer, or reward. For example, children may be rewarded with a series of successful moves in a displayed video game. Depending on the type of biofeedback, individuals may need up to 30 sessions with a trained professional to learn the techniques required to control their symptoms on a long-term basis. Therapists usually recommend that their patients practice both biofeedback and relaxation techniques on their own at home.


Research and General Acceptance

Preliminary research published in late 1999 indicated that neurofeedback might be a promising new tool in the treatment of schizophrenia. Researchers reported that schizophrenic patients had used neurofeedback to simulate brain wave patterns that antipsychotic medications produce in the brain. Further research is needed to determine what impact this may have on treatment for schizophrenia.

The use of biofeedback techniques to treat an array of disorders has been extensively described in the medical literature. Controlled studies for some applications are limited, such as for the treatment of menopausal symptoms and premenstrual disorder (PMS). In recent years, neurofeedback has been used successfully with Attention Deficit Disorders in school children as well as adults with concentration problems.

Extensive research has been done on the efficacy of EEG neurofeedback for ADD/ADHD, most notably by Dr. Joel Lubar. There are several good resource websites for reading-up on the latest research in neurofeedback and biofeedback. The Association for Applied Psychophysiology and Biofeedback (ww.aapb.org), the Biofeedback Foundation of Europe ( www.bfe.org ) are two of the best.

Biofeedback has been researched in the areas of Pain Management, Migraine and Tension Headaches, Depression and Anxiety Disorders, PTSD, Sleep Disorders, Brain Injury and Stroke, Chronic Fatigue and Fibromyalgia, Autism, Asberger's, Tourettes, and Epilepsy.

The efficacy of neurofeedback is enhanced by other adjunct therapies such as: Cognitive-Behavioural therapy, relaxation techniques, guided imagery and body-work techniques.

Neurotherapy, as a self-empowering educational tool has often been the therapy of choice by parents and teachers of young children who are looking for an alternative to medication to assist with concentration problems.


Applications

This specialized type of training allows people to gain control over physiological reactions that are ordinarily unconscious and automatic. Malfunctions in these automatic responses contribute to a wide variety of medical problems. In study after study, biofeedback has shown the ability to help bring such counterproductive reactions back into line, providing significant relief for many of the people who try it.

Although it's not a sure cure, biofeedback helps many people with chronic pain, including the pain of arthritis, muscle spasms, and headache (both migraine and tension headache). It can reduce tension and anxiety, combat chronic insomnia and fatigue, alleviate depression, reduce hyperactivity and attention deficit disorder, and even help overcome alcoholism and drug addiction. Some people have found it helpful for controlling high blood pressure or an abnormal heart rate. It's also useful for retraining, reconditioning, and strengthening muscles after an accident or surgery, restoring loss of control due to pain or nerve damage, and overcoming urinary (or bowel) incontinence.

For asthmatics, biofeedback offers the possibility of controlling bronchial spasms and reducing the severity of attacks. Many victims of Raynaud's disease (periodic loss of circulation in the fingers) have been able to rectify the problem through biofeedback. The technique has helped others deal with digestive disorders such as ulcers, irritable bowel syndrome, acidity, dysfunction of the oesophagus, and difficulty swallowing.

Biofeedback is under study as a potential aid in the treatment of a number of other ailments as well, although results are more mixed. It may help relax the muscles in temporomandibular joint syndrome (TMJ). It appears to reduce the severity and frequency of seizures in some (though not all) epileptics. It can help ease the symptoms of chronic fatigue syndrome. It has even been tried as a remedy for chronic constipation, motion sickness, and the uncontrollable tics and compulsions of Tourette's syndrome.

Basic Summary of Applications (incomprehensive):

  • Migraine headaches.
  • Tension headaches.
  • Other types of chronic pain.
  • Disorders of the digestive system.
  • Incontinence.
  • High blood pressure.
  • Cardiac arrhythmias (abnormalities in the rhythm of the heartbeat).  
  • ADD/ADHD (Attention Deficit Hyperactive Disorder).
  • Raynaud's disease (a circulatory disorder that causes uncomfortably cold hands),
  • Epilepsy.
  • Paralysis, spinal cord injury and other movement disorders.
  • Tourette's Syndrome.
  • TMJ (temporomandibular joint syndrome).
  • Chronic fatigue syndrome.
  • Asthma.
  • Alcoholism and drug addiction.
  • Digestive disorders such as ulcers, irritable bowel syndrome, acidity, dysfunction of the oesophagus, and difficulty swallowing.
  • Chronic constipation.
  • Motion sickness

How the Treatments Are Done

Biofeedback is not a passive treatment. It requires intensive participation as the client learns to control such normally involuntary ("autonomic") functions as heart rate, blood pressure, brain waves, skin temperature, muscle tension, breathing, and digestion.

At the client's first session, the client might be asked a few questions about his own health and that of family members. The biofeedback therapist will then apply sensors to various points on the client's body. The location depends on the problem that needs treatment. If the client has migraines, sleep problems or mood disorders, for example, the electrodes are often attached to his scalp. To treat heart problems or muscle tension, the electrodes will be placed on the client's chest, or on the skin covering the problematic muscle. Other possible sites include the hands, fingers, shoulder, back and jaw.

The sensors are connected to a computer with appropriate software, or another piece of monitoring equipment that provides instant feedback to the client on the function he or she is trying to control. The tension in a particular set of involuntary muscles or circulation to a specific part of the body may be focused upon. Some biofeedback machines signal changes graphically on a computer display. Other monitors beep, buzz, or blink to indicate the strength or level of the function targeted.

The therapist will teach the client mental or physical exercises that can help affect the dysfunction that's causing a problem. One can easily gauge ones success by noting any changes in the intensity, volume, or speed of the signals from the machine. Gradually, the client will learn to associate successful thoughts and actions with the desired change in their involuntary responses.

Once the client has thoroughly learned an effective pattern of actions, they will be able to assert control without the aid of the feedback device.

Among the feedback instruments you're most likely to encounter are the following:

Electroencephalographs (EEGs) measure brain-wave activity. Conditions that may benefit from training on these machines include attention deficit/hyperactivity disorder, tooth grinding, head injuries, and depression (including bipolar depression and seasonal affective disorder).

Electromyographs (EMGs) measure muscle tension. Therapists use them to relieve muscle stiffness, treat incontinence, and recondition injured muscles.

Skin Temperature Gauges show changes in the amount of heat given off by the skin, a measurement that indicates any change in blood flow. These gauges are used in the treatment of Raynaud's disease, high blood pressure, anxiety, and migraines.

Galvanic Skin Response Sensors (GSRs) use the amount of sweat you produce under stress to measure the conductivity of your skin. They are often used to reduce anxiety.

Electrocardiographs (ECGs) monitor the heart rate and may be useful in relieving an overly rapid heartbeat and controlling high blood pressure.

Respiration Feedback Devices concentrate on the rate, rhythm, and type of breathing to help lessen symptoms of asthma, anxiety, and hyperventilation and promote relaxation.

Along with biofeedback training, the therapist may also give instruction in deep breathing, meditation, visualization, and muscle relaxation--all of which may aid in relieving stress-related symptoms.

Treatment Time: Sessions usually last between 30 minutes and 1 hour.

Treatment Frequency: In most cases, people can learn to raise or lower their heart rate, relax specific muscles, lower blood pressure, and control other functions in 8 to 10 sessions. Some problems, such as attention deficit/hyperactivity disorder, take longer--sometimes up to 40 sessions. Depending on the severity of the problem and the technique used, therapists suggest you attend 1 to 5 sessions per week.

Preparations

Before initiating biofeedback treatment, the therapist and patient will have an initial consultation to record the patients medical history and treatment background and discuss goals for therapy.

Before a neurofeedback session, an EEG is taken from the patient to determine his or her baseline brainwave pattern.

Biofeedback typically is performed in a quiet and relaxed atmosphere with comfortable seating for the patient. Depending on the type and goals of biofeedback being performed, one or more sensors will be attached to the patient's body with conductive gel and/or adhesives. These may include:

  • Electroencephalography (EEG) sensors. These electrodes are applied to the scalp to measure the electrical activity of the brain, or brain waves.
  • Electromyography (EMG) sensors. EMG sensors measure electrical activity in   the muscles, specifically muscle tension. In treating TMJ or bruxism, these sensors would be placed along the muscles of the jaw. Monitoring electrical energy in other muscle groups might treat chronic pain.
  • Galvanic skin response (GSR) sensors. These are electrodes placed on the fingers that monitor perspiration, or sweat gland activity. The term "skin conductance" is used to monitor levels of anxiety.
  • Temperature sensors. Temperature, or thermal, sensors measure body temperature and the changes that result from therapeutic interventions.
  • Blood-volume Pulse (BVP) monitors changes in blood flow to the extremities.
  • Heart rate sensors. A pulse monitor placed on the fingertip can monitor pulse rate. ECG sensors are used above the area of the heart, on the chest.
  • Respiratory sensors. Abdominal and thoracic breathing sensors assist the client in relaxation therapy and deep breathing exercises. Respiratory sensors sometimes monitor oxygen intake and carbon dioxide output.

Individuals who use a pacemaker or other implantable electrical devices should inform their biofeedback therapist before starting treatments, as certain types of biofeedback sensors have the potential to interfere with these devices.

Biofeedback may not be suitable for some patients. Patients must be willing to take a very active role in the treatment process. And because biofeedback focuses strictly on behavioural change, those patients who wish to gain insight into their symptoms by examining their past might be better served by psychodynamic therapy.

Patients with specific pain symptoms of unknown origin should undergo a thorough medical examination before starting biofeedback treatments to rule out any serious underlying disease. Once a diagnosis has been made, biofeedback can be used concurrently with conventional treatment.

Biofeedback may only be one component of a comprehensive treatment plan. For illnesses and symptoms that are manifested from an organic disease process, such as cancer or diabetes, biofeedback should be an adjunct to (complementary to), and not a replacement for, conventional medical treatment.


Side effects

There are no known side effects to properly administered biofeedback or neurofeedback sessions.


What the Treatment Hopes to Accomplish

Biofeedback is a "mind over matter" form of therapy that has only recently begun to filter into mainstream medicine. Although ancient Greek, Chinese, and Indian healers were convinced that the mind could influence the body, either causing illness or curing disease, the concept fell into disrepute as Western medicine began to discover the infectious agents and chemical malfunctions that lie at the root of so many familiar ailments. It was only when modern instrumentation made it possible to measure subtle changes in unconscious physical reactions that medicine once more turned its attention to the mind-body connection.

Although biofeedback is able to remedy certain ailments through disciplined mental effort, it differs from other forms of mind-body therapy such as meditation and yoga. It does not rely on maintenance of some sort of theoretical balance or harmony in order to achieve its effects. Instead, it seeks control can prove especially useful for any disorder caused or aggravated by involuntary muscular tension or tightening.