Deidre Donaldson and Dennis Russo

Keywords: behavioral medicine, biofeedback, EEG or electroencephalogram, EMG or electromyogram

Biofeedback is the process of providing an individual with physiological data of which he or she might be otherwise unaware. A key assumption is that by providing "feedback" to the individual about physiological responses ("bio"), it is possible for the individual to learn to become aware of and exert direct control over the physiology, the focus in clinical settings being to improve health outcomes.

Although the theoretical underpinnings of biofeedback (primarily physiological and learning) have existed since the turn of the century, biofeedback emerged as a clinical intervention in the late 1960s. The application of biofeedback to clinical problems evolved from laboratory research on operant control of the autonomic nervous system in animal models. Interest in biofeedback as a clinical application coincided with popular interest in altered states of consciousness and activities focused on reducing autonomic arousal (Roberts, 1985). This combination of scientific and popular interest in biofeedback and related applications fueled its popularity and generated widespread application throughout the 1970s and 1980s. Simultaneous advances in the technology used to measure the physiology, specifically electronics and computers, have further perpetuated this trend.

One of the central uses of biofeedback from a cognitive-behavioral point of view is to promote the acquisition of self-control training or self-regulation skills. For example, in behavioral medicine, the use of biofeedback assists the clinician in monitoring and guiding treatment involving relaxation training. As the client demonstrates control over the physiology, positive reinforcement may be provided. Thus, biofeedback is not a treatment modality per se but an adjunct to assist in the process of treatment. The field of cognitive-behavior therapy includes biofeedback as just one of many options in its armamentarium of biobehavioral treatment components. The feedback loop created by biofeedback has been theorized to result in cognitive change (for example, improved self-efficacy) that may also be important in the treatment process. This requires thorough knowledge of cognitive-behavior therapy in addition to specialized training in biofeedback. The American Association for Applied Physiology and Biofeedback is devoted to promoting the use of biofeedback and offers professional trainings. Board certification in biofeedback is also available through the Biofeedback Certification Institute of America (BCIA).

Biofeedback technology requires at least one sensor to obtain physiological information, a repository for this information, and a method of translating or feeding this information back to the patient. This is most commonly done through the use of a computer. Sensors are connected to the patient to monitor the indices of interest. These sensors connect the patient to the computer and special software reads the data and translates it to the monitor, allowing the information to be communicated to the patient in visual or graphical form. This is referred to as "computer-assisted biofeedback." Advances in computer technology have improved patient access to biofeedback as a clinical modality and further perpetuated its widespread application. Improvements in computer software have made biofeedback more user friendly and broadened its appeal to the general population. Patients now ask for biofeedback because of its technological appeal without any further knowledge of how it works.

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