Biofeedback Is Back
Imagine having hands so sensitive to cold that each winter they would swell and split open, so that just grabbing a carton of milk out of the refrigerator makes them whiten and throb with pain. Then imagine learning to raise the temperature in your hands so that you could hold the carton of milk and do it without any pain.
This is an example of what biofeedback training may be able to accomplish for certain medical problems such as Raynaud's disease, a circulatory disorder that can cause its victims extreme discomfort and debilitation.
Biofeedback training as a tool for relaxation and stress reduction enjoyed a brief surge of popularity following its inception in the late 1960s, but exaggerated claims based on poor-quality studies led to a backlash against it. Biofeedback largely slipped out of the public view during the 1970s and 1980s. In the 1990s, however, properly designed studies were performed, and biofeedback began to regain respect.
Currently, incomplete but encouraging evidence suggests that biofeedback may indeed offer at least modest benefits for a variety of medical conditions, including hypertension, anxiety, Raynaud's syndrome, low-back pain, insomnia, fecal incontinence in children, irritable bowel syndrome, and migraine and tension headaches. Biofeedback does not appear to be effective for asthma.
Neurofeedback, the "retraining" of brainwave patterns is experiencing a resurgence of interest in the treatment of a variety of disorders, including depression, attention-deficit hyperactivity disorder (ADHD), and alcoholism. However, it remains controversial.
Not a Quick Fix, but a Long-Term Solution
The major advantages of biofeedback are that it is noninvasive, has virtually no side effects, and is effective over the long-term. The major disadvantage for some is that it requires effort, commitment, and involvement on the part of patients.
How Biofeedback Works
Every time you scratch an itch, grab a snack when you're hungry, or use the bathroom when you feel the urge, you are responding to biofeedback cues from your body about your physiologic state.
With biofeedback training, however, you are cued by sensors attached to your body. These sensors measure heart rate, the temperature of your extremities, the muscle tension in specific muscle groups, or, in neurofeedback, the kinds of brain waves you are emitting. This information is conveyed by visual displays or sounds. Using imagery and mental exercises, you learn to control these functions, using the feedback provided by the sensors as a gauge of success. With practice, you can learn to "tune in" without instrumentation, and control these functions at will during ordinary life.
For example, in a biofeedback training session for headache, Larsson would attach temperature sensors first to your hands, then to your feet, and finally to your forehead, if needed. Your goal would be to increase blood flow away from the brain by raising the temperature in your hands and feet and eventually lowering it in your temples. Other sensors might monitor your electrodermal or galvanic skin response, how easily you sweat or get goose bumps, because this affects your ability to alter your skin temperature.
To warm up your hands and feet, you might imagine basking in the sun on a beach while listening to a script like "I feel warm...my hands are growing warm and heavy..." Both the image and the script would be tailored to you personally to evoke a vivid and relaxing mental image. After your training session, you'd be sent home with this script on audiotape and small thermometers to use for your daily practice.
How Effective Is Biofeedback?
The type of problem being treated and the motivation of the patient are often the key determinants of biofeedback success. For problems like Raynaud's disease or bed-wetting in children, biofeedback has shown some effectiveness, but success rates vary widely. Success rates for established biofeedback protocols for incontinence, anxiety, headaches, and hypertension vary, but most controlled studies report at least modest significant improvement in many participants.
Any biofeedback treatment program should involve your primary health care provider and relevant specialists, such as urologists, cardiologists, or neurologists. The training is often most effective when integrated with other types of therapy, such as medication or cognitive behavioral therapy. Sometimes, as was found in one study of patients with essential hypertension, biofeedback therapy can allow you to substantially cut back or even eliminate some medications.
Neurofeedback—The Biofeedback Frontier
Neurofeedback, also called EEG feedback, is the most controversial form of biofeedback therapy, largely because so few controlled clinical trials have been able to assess its efficacy. Early research suggest that it may be effective in the treatment of ADHD, hyperkinesis, depression, epilepsy, and alcoholism.
Other areas of investigation include the treatment of premenstrual syndrome, stroke rehabilitation, anxiety, Tourette syndrome, and chronic fatigue syndrome. Like all biofeedback, neurofeedback is noninvasive and has few or no side effects, although some subjects feel temporarily dizzy or disoriented after a training session.
In a neurofeedback training session, several sensors that measure your brain's electrical activity are attached to your scalp. You relax and play a video game, which is controlled just by your brain waves and responds favorably to brain waves of the desired pattern. As you play the game, your trainer observes your EEG, transmitted to a separate video terminal. Most practitioners recommend at least 20 sessions to obtain significant, long-lasting results, although improvement is usually noted early on if the treatment protocol is right for you.
A note of caution: because the field is so new, many practitioners have little or no experience beyond a week-long training session, so ask lots of questions and talk with your primary care provider before embarking on a treatment program.
Cost of Biofeedback Training
Some insurance companies and HMOs offer partial coverage for biofeedback. The cost of an individual training session ranges from $60 to $150.
Applied Psychophysiology and Biofeedback
Biofeedback Certification Institute of America
Healthcare Information Resources
Women's Health Matters
Applied Psychophysiology and Biofeedback. Available at: http://www.aapb.org.
Last reviewed February 2008 by Jill D. Landis, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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