Biofeedback, or applied psychophysiological feedback, is a patient-guided treatment that teaches an individual to control muscle tension, pain, body temperature, brain waves, and other bodily functions and processes through relaxation, visualization, and other cognitive control techniques. The name biofeedback refers to the biological signals that are fed back, or returned, to the patient in order for the patient to develop techniques of manipulating them.
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. Willer's work was expanded by other researchers. 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 excess stomach acid, 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.
Biofeedback has been used to successfully treat a number of disorders and their symptoms, including tempromandibular joint disorder (TMJ), chronic pain, irritable bowel syndrome (IBS), Raynaud's syndrome, epilepsy, attention-deficit hyperactivity disorder
Illnesses that may be triggered at least in part by stress are also targeted by biofeedback therapy. Certain types of headaches, high blood pressure, bruxism (teeth grinding), post-traumatic stress disorder, eating disorders, substance abuse, and some anxiety disorders may be treated successfully by teaching patients the ability to relax and release both muscle and mental tension. Biofeedback is often just one part of a comprehensive treatment program for some of these disorders.
NASA has used biofeedback techniques to treat astronauts who suffer from severe space sickness, during which the autonomic nervous system is disrupted. Scientists at the University of Tennessee have adapted these techniques to treat individuals suffering from severe nausea and vomiting that is also rooted in autonomic nervous system dysfunction.
Recent research also indicates that biofeedback may be a useful tool in helping patients with urinary incontinence regain bladder control. Individuals learning pelvicfloor muscle strengthening exercises can gain better control over these muscles by using biofeedback. Sensors are placed on the muscles to train the patient where they are and when proper contractions are taking place.
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 beat, 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 (underarousal) or the high end (over-arousal) of that spectrum. Underarousal might be present in conditions such as depression or attention-deficit disorder, and overarousal 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,
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.
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.
ELMER GREEN 1917–
A life dedicated to science has propelled Elmer Green, Ph.D. into careers as a physicist and a biological psychologist. Both led to his most noted work, the influence on the birth of the biofeedback movement. While the mechanics of moving parts and machinery lured the investigator from LaGrand, Oregon, to his work as a civilian scientist with the Navy in the late 1940s, it was his wife Alyce who caused him to ponder biophysiology and human development. In 1953 she read a book titled The Human Senses by Frank Geldard. It was their interests as a couple that led to their continued education at the University of Chicago. In 1957 Green began work for his Ph.D. studies in biopsychology, while Alyce studied for her Master's degree in psychology.
Numerous opportunities, including assisting with the development of a machine for the automated detection of brain damage, led to his position at the Menninger Institute in Topeka, Kansas, in 1964. While there he established the psychophysiology laboratory and the Voluntary Controls Program. It was his treatment of a colleague's wife's headaches that Green became convinced that skin temperature was an autonomic nervous system variable that was responsive to psychophysiologic self-regulation aided by thermal biofeedback. By learning to control temperature he found that headache control could be enhanced. Green's success attracted support by several of the Menninger staff who also began research and use of biofeedback therapy for headaches and hypertension.
The 1960s proved exciting for Green as he, Alyce, and colleague Dale Walters became involved with EEG Biofeedback, and studied the process of meditation—a therapy the Greens had long practiced. In April 1969, Green and his wife organized the Council Grove Conference for the study of the voluntary control of internal states. The conference served as a step toward forming the Biofeedback Research Society, which later became the Biofeedback Society of America, and currently the Association for Applied Psychophysiology and Biofeedback.
Together, Elmer and Alyce Green authored numerous papers, book chapters, and wrote the book, Beyond Biofeedback (1977). They lectured throughout the United States and around the world for more than 20 years on multiple topics including EEG biofeedback training and psychophysiologic control.
Green co-founded the International Society For the Study of Subtle Energies and Energy Medicine (ISSSEEM) in 1990 and served as its director. Alyce died in 1994 of Alzheimer's disease. In 2000, 81-year-old Green worked as a professional consultant and director emeritus of the Voluntary Controls Program at the Menninger Clinic. He also served as the science director of the Dove Health Alliance in Aptos, California.
Beth A. Kapes
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:
- Electromyographic (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. Chronic pain might be treated by monitoring electrical energy in other muscle groups.
- Galvanic skin response (GSR) sensors. These are electrodes placed on the fingers that monitor perspiration, or sweat gland, activity. These may also be called skin conductance level (SCL).
- Temperature sensors. Temperature, or thermal, sensors measure body temperature and changes in blood flow.
- Electroencephalography (EEG) sensors. These electrodes are applied to the scalp to measure the electrical activity of the brain, or brain waves.
- Heart rate sensors. A pulse monitor placed on the finger tip can monitor pulse rate.
- Respiratory sensors. Respiratory sensors 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 behavioral 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.
There are no known side effects to properly administered biofeedback or neurofeedback sessions.
Research & general acceptance
Preliminary research published in late 1999 indicated that neurofeedback may 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.
- Raynaud's syndrome
- —A vascular, or circulatory system, disorder which is characterized by abnormally cold hands and feet. This chilling effect is caused by constriction of the blood vessels in the extremities, and occurs when the hands and feet are exposed to cold weather. Emotional stress can also trigger the cold symptoms.
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). There is also some debate over the effectiveness of biofeedback in ADHD treatment, and the lack of controlled studies on that application. While many therapists, counselors, and
There may also be some debate among mental health professionals as to whether biofeedback should be considered a first line treatment for some mental illnesses, and to what degree other treatments, such as medication, should be employed as an adjunct therapy.
Training & certification
Individuals wishing to try biofeedback should contact a healthcare professional trained in biofeedback techniques. Licensed psychologists, psychiatrists, and physicians frequently train their patients in biofeedback techniques, or can recommend a specialist who does. In some cases, a licensed professional may employ a biofeedback technician who works under their direct guidance when treating patients. There are several national organizations for biofeedback therapists, including the Biofeedback Certification Institute of America, which also certifies therapists in the practice.
Robbins, Jim. A Symphony in the Brain: The Evolution of the New Brain Wave Biofeedback. Boston, MA: Atlantic Monthly Press, 2000.
Burgio, K.L. et al. "Behavioral vs. Drug Treatment for Urge Urinary Incontinence in Older Women: A randomized controlled trial." Journal of the American Medical Association 280 (Dec. 1998): 1995-2000.
Robbins, Jim. "On the Track with Neurofeedback." Newsweek 135, no. 25 (June 2000): 76.
The Association for Applied Psychotherapy and Biofeedback. 10200 W. 44th Avenue, Suite 304, Wheat Ridge, CO 80033-2840. (303) 422-8436. <http://www.aapb.org>.
Biofeedback Certification Institute of America. 10200 W. 44th Avenue, Suite 310, Wheat Ridge, CO 80033. (303) 420-2902.