Biofeedback therapy uses monitoring equipment to ‘feed back” to.people physiologic information of which they are not normally aware. By watching the monitoring device, individuals can learn to adjust their thinking and other mental processes to control body processes such as blood pressure, brain-wave activity, gastrointestinal functioning, and body temperature.
WHAT IT IS
Biofeedback is based on the principle that any function that can be monitored and displayed (or “fed back”) to a person can then be regulated by that person. Modern electronic equipment can monitor internal responses and con-vert them to visual or auditory information that can then be used to regulate the response.
Biofeedback enables individuals to see how their breathing, posture, and thinking affect certain bodily responses, such as the heart rate. For example, when a person takes slow, deep breaths, the heart rate decreases. Thinking relaxing thoughts can also slow the heart rate. When people think about a stressful situation, however, the heart rate increases.
EQUIPMENT
The monitoring device used depends on what condition the patient is being treated for and the response to be regulated. For example, the biofeedback technician may use electroencephalogram (EEG) feedback to mea-sure brain-wave activity. The resulting information relayed back to the patient is used to help him or her achieve a relaxation response.
A common form of biofeedback involves the measurement of muscle tension via electromyographic, or EMG, feed-back. Electrodes are attached to the involved muscles to measure electrical energy from the patient. Information from the electrodes is fed into a small monitoring box that registers the results either through sound or sight. For example, sound may vary in pitch as the function being monitored decreases or increases. Visual meters may vary in brightness as the response varies.
There are a number of other biofeedback tools for a variety of purposes, including skin temperature (known as thermal feedback) and electrical conductance or resistance of the skin (electrodermal feedback). Increasingly sophisticated measurement devices now allow a number of other responses to be measured and then fed back to the patient. These include
- esophageal motility—the muscular action involved in swallowing
- stomach acidity—the amount and concentration of secretions in the Stomach
- activity of the detiusor muscle of the bladder—used to treat urinary incontinence
- activity of the internal and external rectal sphincters—used to treat bowel incontinence
TECHNIQUES
Biofeedback works best when patients can achieve a meditative state of deep relaxation. Many patients like biofeedback because it pub them in control and provides a sense of self-reliance over their health.
Biofeedback therapists teach patients mental exercises to reach the desired result, such as muscle relaxation or con-traction. Through trial and error, patients learn to control their inner responses. Raining time varies from person to person and depends on the disorder being treated. Raining for some disorders requires eight to ten sessions before the patient can control his or her response without the help of a monitoring machine.
USES
Biofeedback is used to treat some 150 conditions. and its use for some conditions has already gained widespread acceptance. For example, the American Medical Association has endorsed the use of EMG biofeedback training for treating muscle-contraction (tension) headaches.
The effectiveness of biofeedback has been demonstrated in a number of conditions, including
- alcohol and other addictions
- anxiety
- asthma
- bowel and urinary incontinence due to muscle spasms
- epilepsy
- headaches
- heart irregularities
- high blood pressure
- irritable bowel syndrome
- migraines
- muscle dysfunction
- neuromuscular disorders
- Raynaud disease
- respiratory problems
- sleep disorders
- vascular disorders
Since 1961, there have been more than 3,000 articles and 100 books published describing biofeedback and its many uses. While biofeedback has been demonstrated to be effective for a wide variety of disorders, it is more useful for some conditions than others.
Biofeedback is the preferred method of treatment for certain types of bowel and urinary incontinence, as well as Raynaud disease, which is a painful and potentially dangerous spasm of the small arteries. Biofeedback is one of several preferred treatments for certain patients with attention deficit disorder, epilepsy, asthma, headaches, high blood pressure, and irritable bowel syndrome (also known as spastic colon).
HISTORY
When experimental psychologist Neal Miller pro-posed in 061 that the autonomic nervous system—the part of the nervous system that we don’t use consciously—was trainable, he was met with considerable skepticism. Prevailing thought was that autonomic responses, such as blood pressure and heart rate, could not be controlled. In fact, medical dictionaries of the time defined autonomic as “not subject to voluntary control.” Miller’s ground-breaking work showed that these responses could indeed be controlled through instrumental learning.
BOWEL INCONTINENCE
A number of studies from across the world have shown biofeedback to be a highly effective therapy for adult’s and children who suffer from bowel incontinence. Patients learn to squeeze their anal sphincter through feedback from a monitor that measures sphincter pressure.
A study of 13 children who had not responded to conventional therapy found biofeedback to be effective in 12 after one course of therapy (1). In adults, a study of 15 patients with bowel incontinence found that biofeedback helped 73 percent (2). Another study of 28 patients with bowel incontinence found that 46 percent achieved excellent results, 28 percent had good results, but 25 percent did not improve after biofeedback therapy (3).
CONSTIPATION
Other studies show that biofeedback can also help people who suffer from severe constipation by teaching them to relax their anal sphincter. For example, a study of 26 children with chronic severe constipation corn-pared standard medical care of enemas followed by laxative therapy and diet modification to standard medical ore and biofeedback. Sixteen months later, parents of the children treated with biofeedback reported that the children had significantly less constipation and fewer painful bowel movements and used fewer laxatives than those who received standard care alone (4).
HEADACHES
A study of 25 patients with migraine headaches compared biofeedback therapy with relaxation techniques not aided by biofeedback. The group trained in biofeedback had significantly less pain and used less pain medication than the other group (5).
Another study of 10 women with migraines found a significant decrease in migraine episodes after 16 semiweekly sessions. The decreases continued after therapy as well (6). Among children with migraines treated with biofeedback, another study found 80 percent showed clinical improvement (7).
Thermal biofeedback is commonly used for migraine therapy. And research suggests its effectiveness can be improved through regular practice of thermal biofeedback techniques such as hand warming. A study of 17 women who regularly experienced migraines compared those who received biofeedback training twice a week with those who received the training in addition to practicing hand warming at home. Persons who practiced hand warming at home had greater decreases in headaches and the use of pain medication (8).
Tension (or muscle-contraction) headaches can also be treated by biofeedback using EMG feedback. A study of 26 tension-headache sufferers found EMG biofeedback to decrease headaches in 50 to 100 percent of those treated compared with only 37 percent of persons in a relaxation control group. The variation among the patients who received biofeedback therapy reflects the finding that the success rate may depend on where exactly the electrodes are placed (9).
HIGH BLOOD PRESSURE
A study of 19 patients with high blood pressure found a significant decline in blood pres-sure among patients who received biofeedback therapy and muscle relaxation therapy compared with a tendency for increased blood pressure among those who received muscle relaxation therapy alone (10).
PAIN
A study of 57 patients with chronic back pain and 21 patients with temporomandibular (jaw) pain and dysfunction found that patients who received biofeedback training had significant reductions in pain (11). Another study of 44 patients with chronic lower-back pain found biofeedback to be effective in reducing pain and improving functioning (12).
REHABILITATION
Stroke patients commonly experience difficulties in walking due to alterations in their gait cycle and foot-drop on the affected limb. A study of 16 stroke patients analyzed how electromyographic biofeedback treatment augmented conventional physical therapy. The patients who received biofeedback had significant improvements in their walking (13).
A review of eight studies including 192 stroke patients determined that the use of EMG biofeedback is an effective method for neuromuscular reeducation. Other research suggests that biofeedback may also help patients who have difficulty swallowing (dysphagia) after a stroke (14).
RESPIRATORY FUNCTION
Biofeedback has also been shown to improve breathing and lung function in patients with cystic fibrosis. A study of 26 persons with cystic fibrosis found that those who underwent eight sessions of biofeedback to learn breathing retraining and relaxation techniques had significant improvements in lung capacity and expiration (15).
URINARY INCONTINENCE
A study of 64 women with urinary incontinence found that alternating biofeedback and intravaginal electrical stimulation resulted in complete recovery for 21, recovery sufficient to avoid other forms of treatment for 20, and no success in 23, for an overall success rate of 64 percent (16).
WHO DOES IT
Biofeedback is used in many health care fields, including dentistry; internal medicine, pain management, physical therapy and rehabilitation, and psychology and psychiatry. There are more than 10,000 biofeedback practitioners in the United States. The Biofeedback Certification Institute of America, created in 1981, maintains standards and certifies those who meet those standards. Candidates must have a relevant degree from an accredited institution of higher education and have had at least 200 hours of formal training in biofeedback.
RESOURCES
- Biofeedback Certification Institute of America
- 10200 West 44th Ave., Ste. 304 Wheat Ridge,
- CO 80033
- 303-420-2902
The Institute certifies practitioners in the field, publishes registers of certified practitioners in biofeedback and in stress-management education, and can provide lists of practitioners in your area.