Biofeedback Mastery

Biofeedback Mastery

Have you ever wondered what Biofeedback is all about? Uncover these unique information on Biofeedback! Are you in constant pain? Do you wish you could ever just find some relief? If so, you are not alone. Relieving chronic pain can be difficult and frustrating.

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Criticisms Of Biofeedback

The most significant criticism of biofeedback involves the limited amount of empirical data supporting its widespread clinical application. In some cases, the application of biofeedback to certain clinical problems has progressed with even limited theoretical rationale, let alone empirical support. Biofeedback by definition can involve a variety of physiological indicators, making its application highly variable. Thus, regardless of empirical findings, treatment using biofeedback is not well standardized. In some settings, biofeedback is equated with relaxation treatment and or variations occur in the specificity and sophistication of the physiological data provided to the individual (e.g., using computerized versus noncomputerized information real-time versus lag-time data). A related problem is that biofeedback is used by clinicians with varying training backgrounds. There is board certification available but it is not required in order to practice. This problem is exacerbated by...

Empirical Support For Biofeedback

Scientific investigation of biofeedback has lagged behind its clinical application. This is true with both adult and child populations. Although a lot of literature on the topic has been published, empirical support for biofeedback has not clearly supported its widespread use. Research during the late 1970s and 1980s focused on the use of biofeedback with adult populations for a variety of disorders. This literature base has been criticized for lack of scientific rigor. From the empirical studies that have been conducted with adults, biofeedback appears to be most useful in combination with other forms of biobehavioral interventions, most notably relaxation training. Specifically, support exists for the use of EMG biofeedback for tension headaches in combination with relaxation training. And, thermal biofeedback in combination with relaxation training appears to be effective in treating migraine headaches (Holroyd & Penzien, 1994). Empirical studies of biofeedback with pediatric...

Biofeedbackassisted Cultivated Low Arousal Relaxation Procedures

Biofeedback or applied psychophysiology (AP) has been most frequently used to assist in the attainment of a relaxed physiological and psychological state. Schwartz has labeled the many procedures aimed at accomplishing this task as cultivated low arousal.'' The paradigm driving these applications is based on the assumption that many disorders (often called functional disorders) in modern medicine are the result of the sympathetic nervous system and the hypotha-lamic-pituitary-adrenaline (HPA) system being driven to excessive levels over a long period of time. Disorders included in this list are many hypertension, headache, irritable bowel syndrome, back pain, asthma, noncardiac chest pain, fibromyalgia, chronic fatigue syndrome, temporomandibular disorder, and perhaps the somatic symptoms of anxiety disorders. Whereas the evidence related to etiology is mixed with regard to most of these disorders, the treatment protocols described next have been fairly successful in reducing or...

Using Neurofeedback to Change Attentional States

Following the early work on seizures, Joel Lubar and others began to work on a neurofeedback application to help improve the attentional abilities of children and adults with attention deficit disorder (ADD or ADHD). A great deal of research has indicated that ADD is often accompanied by an excess of slow brain waves, especially during less compelling tasks such as Neurofeedback has become quite popular over the last 5 years and now plays an important role in the field of biofeedback. If research corroborates the impressions of many clinical trials, it could become a common treatment for many prevalent problems. AROUSAL ATTENTION ELECTROENCEPHALOGRAPHY (EEG) NEUROFEEDBACK PSYCHOPHYSIOLOGY STRESS

Contemporary Uses Of Biofeedback

Biofeedback encompasses any physiological process that can be measured. The most common modes used in contemporary clinical practice assess autonomic nervous system functioning and are summarized in the following table Electromyogram biofeedback involves sensors that measure skeletal muscle tension, particularly in the frontalis (forehead), masseter ( jaw), and trapezius (upper back). Increased electrical firings indicate increased tension (Basmajian, 1989). The goal of EMG biofeedback is to learn to be aware of the cues of muscle tension, avoid escalating tension, and deescalate or reverse tension through the use of certain skills (e.g., progressive muscle relaxation). Thermal biofeedback assesses changes in skin temperature, which indicate changes in blood flow as well as the autonomic nervous system more generally as constriction is related to stress activation. EEG biofeedback measures electrical action of the cortex and translates it into frequencies and amplitudes yielding...

Other Autonomic Biofeedback Methods

A few other types of feedback have been reported that seem to indicate learned regulation of the ANS. Some reports of control of sweat gland activity at the extremities appear credible. Hyperhydrosis is a disorder of excessive sweating. Biofeedback is used, with the signal usually taken from the palms of the hands, to reduce excessive activity. Whether the reduction is an example of direct autonomic control or is secondary to Biofeedback of the oculomotor response to improve accommodation has been reported. Special visual devices are used to improve the muscular component of the visual accommodation for improved acuity.


Today e-Health technological advances in monitoring body systems is a rapidly growing area of research with findings being translated into clinical practice.78,79 Patients are monitoring physiological data, such as peak flow rates and heart rate, that are often rapidly transferred to the provider. Therefore, it is conceivable that in the near future it will be much easier for a patient to use his her own respiratory pattern as feedback to change his her breathing pattern. Over the last decades in sporadic studies biofeedback was shown to reduce respiratory rate and paradoxical breathing, increase tidal volume, increase airway diameter, and decrease weaning time.80,81 With the recent identification of dynamic hyperinflation as one of the primary mechanisms of dyspnea52 there is even more reason to focus on helping patients change their breathing pattern. Recently a group of investigators53 compared the efficacy of a six week 18-session program of ventilation-feedback combined with...

Autonomic Nervous System Regulation

Perhaps the most paradigm-shifting example of biofeedback comes from the applications to modify autonomic parameters. Until the 1960s it was widely believed that the autonomic nervous system, with its sympathetic branch supporting fight-flight and its parasympathetic branch supporting restoration and homeostasis, perhaps could be modified by Pavlovian or classical conditioning, but not by operant conditioning. It was thought that one might be able to condition a reflex to a neutral stimulus (bell-meat for a dog) but that the system could not be brought under voluntary control. In 1969, Neil Miller at Rockefeller University published the results of several studies that showed definitive regulation of autonomic processes such as heart speeding and slowing, urine formation, peripheral blood flow, and blood pressure in lower mammals. The studies were notable because the animals were paralyzed with curare, ruling out any voluntary mediation of the regulation. Miller later showed that...

Case Illustrations

Because of the diverse areas of applications of clinical biofeedback, instead of case examples, two general clinical protocols will be presented. The two clinical protocols selected for presentation will be the protocol for biofeedback facilitated relaxation training (BFRT) and for QEEG feedback for ADD ADHD. These protocols reflect the two major strategies of clinical biofeedback applications biofeedback for relaxation purposes and a specific biofeedback training technique based on specific physiological levels that are related to the diagnostic category.

M Tension and Migraine Headaches

There is a wealth of outcome research demonstrating that these two disorders can be effectively treated with biofeedback techniques. For tension headaches, BFRT, with placements of the EMG sensors in the frontal location, combined with general relaxation techniques, such as PMR has been shown to be effective. Utilization of specific muscle feedback of the muscles of the face, neck, and cervical area has also proven effective. This author recommends the combination of frontal EMG feedback, PMR, and specific muscle feedback of the face, neck, and cervical area. The muscles selected for the feedback are determined by a dynamic EMG assessment. For biofeedback treatment of migraines the treatment of choice is finger temperature feedback combined with a relaxation technique, such as autogenic training. For those clients unresponsive to the finger temperature feedback, usually frontal EMG feedback will be effective. Based on the outcome research, biofeedback should be the treatment of choice...

Example of a BFRT Protocol

When using BFRT, it is first necessary to determine if the client would benefit from such therapy. General relaxation may be helpful in a variety of conditions and it may also be useful as an incompatible response during such procedures as systematic desensitization. BFRT normally takes between 8 and 20 sessions, depending on the acquisition skills and the distress level of the client before and during therapy. After determination of the need for BFRT, the therapist must explain the rationale for biofeedback therapy, outline the basic aspects of the physiological processes that will be trained, and discuss the potential benefits and risks of the training. This author recommends conducting the first BFRT session with frontal EMG feedback, while monitoring other modalities such as finger temperature, SCA, and or heart rate. The therapist may also find it beneficial to monitor additional physiological events that are connected to the specific conditions being treated. During the first...

Suggested Reading

R., and Abarbanel, A. (Eds.). (1999). Introduction to Quantitative EEG and Neurofeedback. Academic Press, San Diego, CA. Lubar, J. S. (1995). Neurofeedback for the management of ADHD disorders. In Biofeedback A Practitioner's Guide (M. S. Schwartz, Ed.), 2nd ed. Guilford, New York. Robbins, J. (2000). A Symphony in the Brain The Evolution of the New Brain Wave Biofeedback. Atlantic Monthly Press, New York. Striefel, S. S. (2000). The role of aspirational ethics and licensing laws in the practice of neurofeedback. J. Neurotherapy 4(1), 43-55. Thatcher, R. W. (2000). EEG operant conditioning (biofeedback) and traumatic brain injury. Clin. Electroencephalography 31(1), 38-44.

Winnie Eng and Richard G Heimberg

Have contributed to the relative slowness in the development of treatments for GAD. First, the diagnostic criteria for GAD have changed a great deal over time. Uncontrollable and excessive worry was not specified as the core feature of the disorder until 1994. As such, past treatments have included nonspecific interventions, such as relaxation training and biofeedback, rather than interventions specific to treating uncontrollable and excessive worry. In line with changes in the diagnostic criteria, there have also been major changes in the way that people understand the etiology and maintenance of GAD. Newer treatments place greater emphasis, for example, on the important role of emotion in GAD. These developments are greatly informed by current cognitive models of the disorder, like that of Tom Borkovec and his colleagues, which suggests that worry functions as a means of avoiding more emotionally laden, painful thoughts. Over the next few years, continued research into the nature of...

Peripheral Nervous System

Nervous System Peripheral Neuropathy

Visceral sensations may intrude deeply upon thoughts and feelings. Often difficult to describe and localize, they are usually unpleasant and at times uncompromising. As biofeedback studies show, the ANS can be classically conditioned. Once activated, it plays a pivotal role in human decision making. It now receives major attention in studies of normal, abnormal, and criminal behavior, with benefit to informed family counseling, crisis mediation, law enforcement, corrections, and society at large.

Richard M Suinn and Jerry L Deffenbacher

Anxiety scene A concrete event from the client's actual experience associated with anxiety being aroused. biofeedback Methods for relaxation training that employ equipment to monitor and provide feedback on physiological responses, such as changes in muscle tension or finger temperature. early warning signs Internal cues such as tension in shoulders, upset stomach, or specific thoughts that indicate the onset or early stages of anxiety arousal. AMT trains clients to attend to these cues and initiate relaxation coping skills to abort anxiety or stress arousal. progressive or deep muscle relaxation A method of relaxation training that has clients systematically tense and release the muscles of the body. relaxation scene A concrete event from the client's actual experience that is associated with being relaxed. relaxation training The process of developing a basic relaxation response, usually done through biofeedback or deep muscle relaxation.

Historical Notes A Early Beginnings

Until about 40 years ago, it was generally believed that brain electrophysiology was not under conscious control and could not be modified through learning. In fact, even today despite much evidence that EEG can be modified rather easily, there are some who assert that this occurs only through mediation by voluntary control of a skeletal muscle response, e.g., deep breathing. The birth of the field of neurofeedback (NF) commonly is reported to have occurred with a serendipitous discovery in the early 1960s. A University of Chicago physiological psychologist, Joe Kamiya, noted that some persons could consciously control bursts of a frequency EEG if asked to do so by simply observing their ongoing EEG tracings. This was quite a revolutionary idea at the time and led to a large amount of research and clinical work on EEG biofeedback through the 1970s. Researchers and clinicians in both medicine and psychology claimed to have demonstrated that most persons not only can learn to...

Biological and Behavioral Influences

Many different biological models of food selection have been developed and most of these are based on homeostatic models (i.e., systems that work to maintain a balance between the intake of energy and or specific nutrients and requirements for them) and are seen to operate via stimulus-response mechanisms of various kinds. Food choice is thus seen as driven either via some kind of internal biofeedback

Dissociative Disorders

Dissociative disorders occur when there is a disruption in the usually unified aspects of consciousness such as memory, affect, perception, and sense of identity. One of the most severe of these disorders is dissociative identity disorder (DID), formerly referred to as multiple personality disorder. Some of the earliest work involving NF and dissociative disorders was done with clients suffering from posttraumatic stress disorder for whom one of the symptoms was dissociation. More recently, some researchers and clinicians have reported successful treatment of DID using NF. Researchers and clinicians who have published reports of their work in this area commonly use other techniques to supplement NF. For example, Carol Manchester required subjects to learn to control body temperature through temperature biofeedback prior to NF and to use various visualization techniques. Along with other NF practitioners who work with DID clients, Manchester trained subjects to increase amplitudes of...

Bearable Electrical Aversion in Treatment of Homosexuality

A related contingent treatment was used in the treatment of male child molesters by Quinsey and colleagues in 1980, although evidence had by then been advanced that penile circumference decreases could paradoxically index increased sexual arousal, and vice versa. The subjects were given biofeedback of their penile circumference responses as if the responses correctly indexed their arousal to pictures of adult and child nudes. The subjects received electrical shock to the arm when they showed circumference increase to the pictures of children. The only outcome reported was change in their penile circumference responses to the pictures following treatment, although again by this time the ability of many men to consciously modify

The Parasympathetic Branch Of The Autonomic Nervous System

Until relatively recently, little attention in biofeedback has been given to the other branch of the ANS, the parasympathetic branch (PNS). Activity from this system is difficult to measure, and it was thought that the sympathetic system was the dominant contributor to stress. However, the evidence to support this idea has not been found. It is difficult to verify sympathetic overdrive'' in the disorders listed earlier. In fact, most patients with functional disorders do not appear to be in obviously stressful circumstances for a sufficient period of time to produce symptoms. This has led some scientists such as Steve Porges at the University of Illinois-Chicago to theorize the importance ofthe PNS

Essential Hypertension

There is substantial research on the treatment of essential hypertension with biofeedback. Studies show that frontal EMG, finger temperature, SCA, and direct blood pressure feedback have all been used successfully. Most of the research supports combining the biofeedback with some relaxation strategy such as progressive muscle relaxation, or autogenic training. Although direct blood pressure feedback might seem superior because it is straightforward, the research does not support it as a treatment of choice, as the other techniques generally reduce blood pressure more than direct blood pressure feedback.

Cancer Patients Psychotherapy

Many group and individual psychotherapy programs teach specific coping skills designed to help patients reduce cancer-related symptoms such as anxiety, anticipatory nausea and vomiting, and pain. Techniques used include specific self-regulation skills such as self-hypnosis, meditation, biofeedback, and progressive muscle relaxation. Hypnosis is widely used for pain and anxiety control in cancer to attenuate the experience of pain and suffering, and to allow painful emotional material to be examined. Group sessions involving instruction in self-hypnosis provide an effective means of reducing pain and anxiety, and consolidating the major themes of discussion in the group.

Pelvic Floor Muscle Feedback for Incontinence and Vulvodynia

A similar application has strong scientific support the retraining of pelvic floor muscles using a vaginal or anal EMG sensor. Feedback from the pelvic floor muscles can help the physical therapist and physician diagnose problems such as muscle weakness, spasti-city, or poor motor control. Then exercises using visual displays of muscle activity are designed and practiced until mastered. This is another rehabilitation model use of biofeedback, but it appears that the feedbackassisted exercises improve motor control and this leads to a series of positive gains for urinary incontinence or painful intercourse (vulvodynia). A similar application can be used for fecal incontinence. The patient can often regain control of his or her bowel function in a few sessions using an anal probe pressure device with instructions to normalize the pattern of contraction and relaxation of the anal sphincters.

Pelvic Floor Disorders

The primary biofeedback applications in pelvic floor disorders are the treatment of urinary and fecal incontinence through the use of EMG biofeedback and specially designed sensors. This section will briefly cover biofeedback for urinary and then fecal incontinence. Urinary incontinence is the inability to maintain control over urinary functions. The goal of biofeedback treatment is to alter both smooth and striated muscle activities related to bladder control. The following methods are employed reinforcement of bladder inhibition, pelvic muscle recruitment, and stabilization of intra-abdominal and bladder pressures during the recruitment of pelvic floor muscles. In order to accomplish these goals, bladder pressure is manipulated and measured while simultaneously measuring pelvic floor muscle activity with EMG sensors. The EMG sensors are specially designed vaginal and anal probes. Fecal incontinence biofeedback is similar, yet different from urinary incontinence biofeedback. Fecal...

Functional Anorectal Disorders Constipation

These behavioural treatments must be provided by experts and comprise a multimodal approach, consisting of habit training, biofeedback (teaching the patient to normalise pelvic floor function while watching real time feedback of sphincter function) help in decreasing the use of laxatives and psychological support. Such treatment will be effective in about two-thirds of patients.

Behavioral Interventions

Behavioral approaches to pain management refer to skills such as relaxation training, pain monitoring, activity scheduling and monitoring, distraction techniques, assertiveness training, and problem solving. To provide some immediate relief from pain, the client can be taught a series of relaxation techniques early in therapy, including deep breathing, progressive muscle relaxation (tensing and relaxing different muscle groups in the body), guided imagery (e.g., imagining a safe place, a place that is free from pain and stress beach or nature scenes), hypnosis (e.g., imagining relaxation moving into different parts of the body), and or biofeedback.

Nonpharmacologic Modalities

Cognitive behavioral and physical techniques are useful nonpharmacological adjuncts to pediatric acute pain management. 5 Several simple, age- and development-specific interventions can significantly decrease a child's anxiety and later pain perception. Cognitive behavioral modalities include reassurance and explanation, relaxation, distraction, music, psychoprophylaxis, biofeedback, and guided imagery. Environmental alterations, such as dimmed lights, a quiet room, or stereo headphones may relieve anxiety. Distraction techniques such as story telling, singing, and games are effective. Guided imagery can be used with children as young as three or four years who have a rich fantasy world and can be encouraged to imagine their favorite place or activity. General strategies for

Nonpharmacologic Modalities Cognitive Behavioral and Physical Therapies for Analgesia and Anxiolysis

Traditionally, nonpharmacologic techniques of pain management in the ED are limited to application of heat or cold, and immobilization and elevation of injured extremities. Other techniques may prove to have a role in the ED and post-ED setting. Among these are cognitive-behavioral techniques, which are effective in reducing pain and anxiety, may control mild pain when used alone, and also enhance patient satisfaction. These techniques include reassurance, explanation, relaxation, music, psychoprophylaxis, biofeedback, guided imagery, hypnosis, and distraction. They are a useful adjunct to pharmacologic management of moderate to severe pain.1 Successful application of these therapies requires a cognitively intact patient and skilled personnel, but many of the techniques require only a few minutes to teach the patient.

Training Requirements

PhD or MD degree and extensive neurofeedback training and experience required for the highest level. Opponents of higher standards sometimes note that undesirable side effects of NF are rare and that, although it may seem incredible (and threatening to established health care professionals), training beyond the bachelor's degree level is not necessary to practice the art of NF and higher standards would be unfair to lesser educated practitioners and to the many persons in need of NF treatment. Although most, if not all, groups currently providing NF training limit enrollment to those with master's level or higher degrees, the field has an unusually diverse group of professionals, including physicians, professional counselors, psychologists, physical therapists, chiropractors, social workers, and nurses. Whereas NF may be a very safe procedure and it may not be essential that its practitioners be knowledgeable about details of EEG dynamics, neuroanatomy, or psychiatric diagnoses,...


EEG biofeedback is the fastest growing area in biofeedback today Part of this interest is due to the fact that changes in instrumentation hardware and software have provided the means to quickly perform mathematical analysis of brain waves so that feedback about the EEG characteristics can be provided within fractions of a second after they are detected. However, recording the EEG is of great technical difficulty because the electrodes must be placed in the correct location while maintaining acceptable levels of impedance. Impedance is the electrical resistance between the electrodes and the skin and must be kept to a minimum in order to reduce unwanted electrical activity. The electrode placements are based on what is called the 10-20 international system, as described by Jasper in 1958. The 10-20 international system identifies positions on the scalp, which are directly over structures of the cortex. The details of electrode placement are beyond the scope of this article, but must...

The Creation of Formal Organizations of Behavioral Medicine The Late 1970sPresent

Members tended to focus on research and limited their services to helping patients modify habits associated with stress, obesity, and smoking. Restricting their interests to these fields, practitioners relied primarily on biofeedback, relaxation training, or simple operant conditioning (Millon, 1982). Millon further suggested that practitioners overlooked other efficacious clinical and therapeutic techniques that could have benefited a greater variety of individuals. Millon reviewed suggestions that this narrow focus was due to the predominance of physiologists and behavioral psychologists involved in the field. Again, arguing the terminology, behavioral in behavioral medicine is also thought to have deterred involvement by professionals from other theoretical orientations. The Society of Behavioral Medicine began two publications, Behavioral Medicine Update and Behavioral Medicine Abstracts, which helped promulgate the aims and efforts of this new discipline.

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...

Relaxation Therapies

Since the late 1950s a host of formal relaxation therapies including progressive muscle relaxation training, autogenic training, imagery training, biofeedback, and hypnosis have all been used to treat insomnia. Common to these approaches is their focus on such factors as performance anxiety and bedtime arousal, which often perpetuate sleep difficulties. Regardless of the specific relaxation strategy employed, treatment entails teaching the insomnia sufferer a formal exercise or set of exercises designed to reduce anxiety and arousal at bedtime so that sleep initiation is facilitated. Typically multiple weekly or biweekly treatment sessions are required to teach relaxation skills that the patient is encouraged to practice at home in order to gain mastery and facility with self-relaxation. The goal of all such treatments is that of assisting the insomnia sufferer in achieving sufficient relaxation skills so that insomnia resulting from sleep-related performance anxiety and bedtime...

Terms And Definitions

Semantics and terminology have had a tremendous impact on the historical documentation of behavioral medicine. For example, Lee Birk first used the term behavioral medicine, which appeared in the title of his book, Biofeedback Behavioral Medicine (1973). Based on this publication, behavioral medicine was mistakenly understood to mean biofeedback (Gentry, 1984).

Vasodilation and Constriction

It appears that humans (and animals) can regulate vasodilatation and vasoconstriction. Robert Freeman and his colleagues have carefully worked out the mechanisms in finger blood regulation using biofeedback training procedures. First, they demonstrated that volunteers could warm or cool their hands upon command. Then they used a series of pharmacological blockades to show that the ability to cool one's fingers is mediated by the sympathetic nerve, but warming above baseline temperature is blocked by a b-andre-nergic blocker in the blood supply. Thus, autonomic voluntary control was demonstrated. Finger warming is a commonly used biofeedback modality.

The Emergence of Behavioral Medicine 1950s1970s

Initially, nonpsychiatric medical professionals considered psychologists and psychiatrists interchangeable. By the mid-1970s, psychologists gradually developed an independent reputation for their unique contributions to health care. Psychologists' expertise included biofeedback training, preventive education, family therapy, and research (Millon, 1982). Yet their status was below that of their psychiatry colleagues (Stone, 1990). The psychologist's job was primarily to focus on emotional and behavioral disturbances that perplexed health care providers (Stone, 1979). Agras (1982) and Miller (1992) suggested three core reasons believed to lead the movement toward behavioral medicine. First, biomedical and behavioral researchers have been unable to independently explain the differences between persons who become ill and those who do not. Thus, prevention was beyond the control of medicine, and etiologies of many illnesses remain unknown. Meanwhile, behaviorally oriented clinicians began...

Controlsystems Theory

Terms control theory and control theory psychology are recent names for describing the development of a body of theory based on a feedback-system model or paradigm. Control theory posits that there are self-monitoring and self-functioning systems in living organisms similar to governors on motors that prevent them from going too fast the control aspect essentially protects the organism from itself. Other current synonymous names for this approach include cybernetic psychology, general feedback theory of human behavior, and systems theory psychology. In the area of learning and conditioning, the biofeedback principles and procedures (i.e., the process of providing an organism with information about its biological functions such as alpha waves, heart rate, blood pressure, blood flow in the extremities) exemplify control systems approaches in both laboratory and practical settings cf., Poiseuille 's law -named after the French physicist Jean L. M. Poiseuille (1797-1869) who verified the...

Choice of Treatment Techniques

The use of technology may facilitate treatment with individuals with MR DD. Some studies showed the successful use of biofeedback to help individuals recognize the differences in their emotional states via an objective external measure. In situations where such advanced technology is not available, trained care providers can act as feedback sources relying on observable changes in mood and behavior.

Muscle Rehabilitation

EMG biofeedback is used to monitor specific muscle activity in order to facilitate recruitment of muscle activity in hypoactive muscles and to reduce muscle activity in hyperactive muscles. The primary role of EMG biofeedback in paretic muscles is to allow the individual to know that some recruitment of muscle activity is being generated even though it may not be enough to cause movement. EMG biofeedback therapy allows the individual to know he or she is correctly activating the muscle but not enough to cause movement, as then the slightest increase in effort is detected by the instrumentation. Any minor successes can be used to build further recruitment until enough activity is generated to cause observable changes, which can then be built into functional movements. For hyperactive muscles, the technique uses specific muscle feedback to reduce inappropriate and sustained muscle contractions.

Sweat Gland Activity

There are two types of sweat glands located in the human skin, the apocrine and eccrine glands. The apocrine sweat glands primarily respond to thermal regulation and the eccrine sweat glands tend to respond to emotionality or arousal level. Therefore, the eccrine glands are of interest in most psychophysiology and biofeedback applications. Eccrine glands have the greatest density in the palm of the hands, the volar sur The eccrine sweat glands have a tubular that travels upward from the gland, through the tissue to the surface of the skin. This tubular has smooth muscle surrounding it and the sweat glands are activated when the smooth muscle opens this tube. Most biofeedback systems measure sweat gland activity by passing a very small electrical signal through electrodes placed on the skin. The opening and closing of the sweat gland causes changes in the resistance of the skin to the electrical current passing through the tissue. The strength of this electrical source is far below...

Nonpharmacological Treatment

Nonpharmacological treatments include behavioral methods and psychological treatment. Behavioral methods include biofeedback, relaxation techniques, and reinforcement of maintaining a regular schedule, exercise, healthy diet, and regular sleep. There are several modalities of biofeedback one can monitor body temperature on electromyography. The final goal is the same the extinction of pain behavior. Relaxation techniques include progressive muscle relaxation and imaginary- and suggestion-based relaxation. These treatments have been proven to be useful for children, pregnant women, and patients for whom stress is a major trigger.

Feedback From Brain Waves

One of the first applications of biofeedback occurred in the 1960s when a great deal of interest in altered states of consciousness arose. A number of researchers in California used newly acquired knowledge from sleep research to study the encephalographic (EEG) aspects of meditative states. It was observed that calm, transcendent states were accompanied by a predominance of a rhythm (8-12 Hz or cycles per second) activity. Biofeedback of this activity was accomplished by providing a tone or other sound when the subject produced a certain amount of the a activity. With shaping, it appeared possible to, in fact, dramatically increase EEG in this band. Many subjects reported meditative types of experiences, and EEG biofeedback was launched as a number of commercial ventures began producing Alpha Trainers,'' promising wondrous results without the time needed to master meditation. Though this trend turned out to be transitory, it did trigger an interest in the use of one's own brain wave...

Future Directions

The use of biofeedback in clinical settings has increased dramatically over the past three decades. At the same time, however, research regarding the underlying mechanisms and effectiveness of this approach lags behind its application. Moreover, results regarding its effectiveness have historically been inconsistent at best, depending on the type of biofeedback examined and the area to which it is applied. It is important that scientist-practitioners continue to empirically examine the utility of biofeedback. This includes not only determining whether it is indeed effective for the myriad of applications for which it has been proposed, but also examining models that forward our understanding of how it works across different applications. It is proposed that different mechanisms may be operating depending on whether biofeedback is used as a primary or secondary intervention. Thus, models for understanding the mechanisms by which it exerts its effects may need to be altered accordingly....

Irritable Bowel Syndrome IBS

IBS is manifested in about 8 to 19 of the population and is associated with symptoms of abdominal pain, constipation and or diarrhea, and gas. About 85 of those with IBS have an increase in symptoms when experiencing stress. Therefore, the treatment of choice is relaxation therapy and research has shown that relaxation therapy combined with finger temperature biofeedback is the most effective. Although more direct forms of feedback have been tried, such as colonic motil-ity sounds, rectal feedback using rectal balloons, and feedback of the electrical activity of the lower gut, these techniques have not proven effective and at this time are not used in general practice. The biofeedback is usually combined with client education about the relationship between stress and symptoms.

Relaxation Techniques

For those finding it difficult to achieve this level of relaxation, many techniques are available. Physicians will frequently respond to meditation, progressive muscle relaxation, selective awareness, self-hypnosis, somatics, yoga, breath control, and biofeedback. Many techniques have audiotapes available to help guide one conveniently through the learning process. For some, religious beliefs and activities may fulfill the need for relaxation. The important common denominator is quiet time that allows for personal reflection, integration, and planning.

Attention Deficit Disorders All Types

There are multiple studies that have shown QEEG biofeedback to be a successful treatment for attentional problems. These studies are based on the rationale that individuals with attentional problems generally have more slow waves in their EEG than individuals who do not have attentional problems. Therefore, the protocol requires the reduction of slow waves, either theta or alpha, while increasing faster waves, such as SMR or beta. The protocol for EEG biofeedback treatment of ADD ADHD will be presented in the section Case Illustrations.

Other Muscular Pain Conditions

Biofeedback from other tense muscle sites (low back, head, shoulders, neck) has also been shown to be clinically useful. Typically patients use relaxation techniques in conjunction with EMG feedback to reduce the sensations of pain or tension. flow to muscle spindles rather than to a reduction of voluntary muscle action potentials, but more needs to be done to elucidate the exact mechanism or active ingredient in the success of EMG biofeedback.

Example of a QEEG Feedback Protocol for Treatment of Addadhd

One of the applications of QEEG biofeedback is with children who are diagnosed with ADD ADHD. These children have been shown to have more slow waves, such as theta and alpha, and fewer fast waves, such as SMR and beta, in their EEGs than non-ADD ADHD children of comparable age, according to Monastra and colleagues in 1999. The biofeedback technique provides QEEG therapy for ADD ADHD children and trains for a decrease in theta or alpha and an increase in beta or SMR, while simultaneously keeping facial EMG levels at an acceptable level. The specific protocol requires a QEEG assessment to determine which specific bandwidth and microvolt levels will be trained. Several studies have been published that clearly demonstrate that the EEG patterns change according to the direction of training and that clinical improvements are observed with successful training. The number of sessions necessary is usually 40 to 60, depending on how quickly the EEG changes and the amount of behavioral...

Eye Movement Desensitization and Reprocessing EMDR

EMDR is a new treatment technique that has received a modest amount of empirical attention. The basic approach includes recognition of images and memories related to the traumatic experience, the psychological problems associated with these images and memories, the development of an alternative mode of interpreting these images and memories, observing the physiological effects of these images and memories on the individual, remaining focused on a corrective appraisal of these images and memories, and the repetition of lateral eye movements as the patient concentrates on aspects of the traumatic experience (Keane & Barlow, 2002). In a clinical trial involving Vietnam theater veterans that compared EMDR to relaxation training, biofeedback, and a comparison group, EMDR subjects did better across all variables measured (Silver, Brooks, & Obenchain, 1995). The components of EMDR include exposure and cognitive interventions, yet research has yet to support the inclusion of the eye movements...


The EMG is the electrical energy generated by the muscles when they contract. The EMG utilized in most biofeedback applications is not the same as the traditional medical EMG used to determine damage to the nerves of the skeletal muscles. The medical EMG typically uses indwelling electrodes and measures latency and amplitude of muscle activity following nerve stimulation, whereas the EMG used in biofeedback applications is usually measured by using electrodes placed on the surface of the skin over the muscles of interest. When specific muscle activity is of interest, concern must be given to placement of the electrodes because research by Lawrence and De Luca in 1983 has shown that the amplitude of the surface EMG is highly correlated with the level of contraction of the muscles when the electrodes are appropriately placed. The EMG is measured with three electrodes by a differential amplifier, which is designed to reduce unwanted electrical signals. With this type of amplifier, one...

N Exclusions

When considering clinical biofeedback for an individual, the following basic requirements must be met The individual must be able to tolerate the application of the sensors the individual must be able to under There are also cautions and contraindications for the use of clinical biofeedback. First, a determination must be made that a more appropriate intervention, such as an immediate medical treatment rather than biofeedback therapy, is not warranted. An example of this is that an individual may be suffering from the recent onset of headaches caused by an aneurysm. In this situation, providing biofeedback as the only treatment would not be sensible, as a surgical intervention may be needed. Although there is little literature on contraindications for psychological states, logic indicates that in certain psychological conditions, biofeedback should not be considered the treatment of choice. These conditions include psychological states such as severe depression, uncontrolled...


Migraine therapy can be classified into four types general measures, abortive therapy, pain relief measures, and prophylactic (preventive) therapy. Overall, the treatment consists of behavioral and pharmacological interventions and is individualized for each patient. General measures includes behavioral therapy, such as recognition and avoidance of migraine triggers, regulation of sleep and meal schedules, dietary modification, stress management, exercise, and biofeedback and other relaxation techniques.


Diagnosis of constipation and encopresis is based on a thorough history and physical examination, with additional laboratory and radiological testing as indicated. Correction of the underlying condition, and correction of dietary composition, and pharmacological therapy usually improve constipation an initial disimpaction and colonic clean-out may also be warranted. For encopresis, additional behavioral therapy is often required. Conditions such as anismus may require additional modalities, such as anorectal manometry to diagnose and biofeedback training to aid in correcting.


Many nondietary, therapeutic approaches to the management of dysphagia have been identified including use of palatal training devices to assist triggering of the swallowing reflex insertion of pros-theses to lower the palatal vault to improve bolus formation oral electrical stimulation oral thermal stimulation drug therapy (nifedipine) high-intensity swallowing therapy exercises to improve where appropriate laryngeal closure, labial mandibular closure, tongue elevation and lateralization use of biofeedback involving mirrors and VSS. Although benefits have been described for many of these interventions, the lack of randomized, controlled clinical trials with adequate power has limited conclusions relating to effectiveness.

Urethral Syndrome

The term urethral syndrome describes a complex of symptoms involving the lower urinary tract including urinary frequency, urgency, dysuria, suprapubic discomfort, postvoid fullness, incontinence, and or dyspareunia with no objective findings of urologic pathology. Grandmultiparity, delivery without episiotomy, two or more abortuses, and pelvic relaxations appear to predispose.3 The true incidence of urethral syndrome in the United States among adult women is unknown, as is the cause. The most widely accepted etiology of this enigmatic syndrome is an inflammatory process. Other etiologies include psychogenic factors, Chlamydia or Mycoplasma infection, atrophic urethritis in the perimenopausal postmenopausal patient, fastidious organism bacterial infection, urethral stenosis and or spasm, allergy, neurogenic, and trauma during intercourse. The diagnosis is one of exclusion founded on a thorough history and physical examination, followed by urine microscopic examination and culture....

Covert Modeling

Covert behaviors can serve a variety of functions. First, they may act as antecedents of other behaviors. They become the covert cues for subsequent behavior. For example, fear and avoidance of many objects are due to covert images of what might happen if one is placed in the fear-producing situation. The most prominent examples of changing the cuing functions of these covert images are systematic desensitization and flooding or implosion therapy. Both of these procedures have been shown by research to be effective in modifying subsequent behavior, though probably not for the reasons originally thought. In systematic desen-sitization, relaxation is used to change the covert cues that arouse the fear and avoidance so that it is no longer aroused to the same degree, beginning with covert cues low on the anxiety-producing hierarchy and gradually moving higher. In flooding, one begins at the top of the fear-producing hierarchy and uses repeated exposure through imagery to the...


Hypnosis is a trance state that combines a heightened inner awareness with a diminished awareness of one's surroundings. It is suggested that hypnosis may modify the cortical centers and the perception of dyspnea, however, the available studies are primarily with asthma patients. Dyspnea decreased in one patient with severe COPD who received hypnotically-induced relaxation and biofeedback in an effort to decrease his dyspnea during periods of anxiety.83 Another 16 patients with asthma had a decrease in their dyspnea from pre- to immediately post-hypnosis and the decrease was sustained 30 minutes after hypnosis.84 Seventeen children and adolescents who had chronic dyspnea with normal lung function that was not responsive to medical therapy were taught self-hypnosis in one or two sessions. Thirteen of the children reported their dyspnea and associated symptoms had resolved within one month of their final hypnosis session. Eleven believed that resolution of their dyspnea was attributable...


While walking or stretching may temporarily alleviate the sensations, current treatment of these disorders has leaned toward medications such as benzodiazepines, opi-oids, and dopaminergic agents. From a behavioral perspective, some symptom relief may be derived from practice of good sleep hygiene (Hening, 2002). For individuals with a mild case of RLS, psychoeducation on sleep, wake, and activity regulation, sleep setting and influences, can assist the individual to regulate behaviors that may be contributing to or exacerbating the dysfunctional movements. These behaviors include regular and adequate sleep hours, as sleep deprivation tends to aggravate RLS. Exercise has been found to assist with the modification of RLS, yet only a moderate amount of exercise has been found to be beneficial since excessive exercise may cause increased exacerbation of symptoms (Hening, 2002). Although behavioral therapies show promise in the decrease of symptoms, empirical support for these findings is...

Finger Temperature

Because the thermister measures the temperature present at its surface, care must be exercised in its proper placement on the area of interest. For most biofeedback relaxation training applications, the ther-mister is placed on the surface of the hand, specifically the fingers. Although there is no research indicating a particular finger or place on the hand as a superior location for the thermister, most clinicians have a preference. The location of choice for this author is the volar tip of the little finger. The rationale that it is the smallest finger and therefore can gain and lose temperature faster than other fingers or areas of the hand. Because skin temperature is determined by blood flow and heat lost to the environment, the smaller the area, the quicker changes in blood flow will be reflected in temperature changes. The thermister has its own mass, so it too must be cooled and heated. Thermisters are available in various grades and sizes. The most desirable thermister is...


Urge incontinence occurs in the setting of detrusor muscle instability. The incidence of this entity is around 15 to 20 percent of all women with incontinence but markedly increases with increasing age. It is often seen in conjunction with stress urinary incontinence also known as mixed incontinence. The precise etiology of urge incontinence is unknown, but it is seen in the presence of foreign bodies (suture inadvertently placed in the bladder), intravesical stones, and or infection. Symptoms include urinary urgency, frequency, nocturia, and incontinence. Observing involuntary detrusor contractions during cystometrics or urodynamic studies is diagnostic. Treatment includes pharmacologic agents (e.g., anticholinergics, b-sympathomimetics, musculotrophics, TCAs, or dopamine agonists), bladder training, biofeedback, and functional electrical stimulation.

Diabetes Mellitus

Diabetes mellitus is caused by the disregulation of insulin produced by a malfunctioning of the pancreas. Because insulin regulates the amount of glucose available to cells, this disorder has serious consequences for life expectancy. The traditional management of diabetes is lifestyle changes through education, diet, and physical exercise along with hypoglycemic medication. The role biofeedback plays in the management of diabetes is through stress reduction techniques with biofeedback-facilitated relaxation training. The BFRT techniques reported in the literature have been frontal EMG training and finger temperature training, usually combined with some form of general relaxation training such as PMR or autogenic phrases. This application helps to stabilize and reduce insulin demands.

Anxiety Disorders

The biofeedback techniques primarily used in the treatment of anxiety disorders are frontal EMG, finger temperature, SCA, and heart rate feedback. These modalities are used to train a deep state of relaxation. The clinician can then use the deep state of relaxation as an incompatible response to the anxiety state. Although specific biofeedback such as heart rate might be used for a cardiac phobic, the most widely used technique is to train on the most active modality, based on the individual's ability and the clinician's experience.

Affective Education

The education program includes activities to detect specific degrees of emotion in others but also detecting and identifying emotions in oneself. This can be done by using internal physiological cues, cognitive cues, and behavior. Technology can be used to identify internal cues in the form of biofeedback instruments such as EMG and GSR machines with auditory or visual feedback.

Anal incontinence

Loperamide reduces the force of bowel contractions and enhances absorption of water from the stool. It may also increase the resting pressure in the anal canal. It can be effective in patients with faecal urgency or leakage and the dose should be titrated to achieve control of symptoms. Dietary modification may also be helpful. Additional behavioural interventions, with bowel focused counselling (biofeedback), including advice on resisting urgency and titrating loperamide can lead to marked improvement in the symptom sometimes even when there is structural damage to the sphincter.

Bruce M Gale

Some of the earliest mainstream applications using technology included the use of biofeedback. Colors and Since then, the scope of technology applications has increased at an exponential rate. Many devices currently in use are more advanced than those described in science fiction novels from earlier decades. Even biofeedback has become more sophisticated due to the increased types of biometric monitoring available, level of interactivity between user and computer, and use of wireless sensors. These changes provide for more precise measurements, a greater sense of involvement, and increased comfort.


Neuromuscular rehabilitation centers have used EMG biofeedback to successfully aid physical therapy and occupational therapy procedures with stroke, spinal cord, head injury, and various neuromuscular disorder patients. Typically, the feedback is used with stimulation and exercises to recruit neuromuscular pathways that are not up to par. It is hard to pin down the components in this protocol. It may improve patient motivation, reopen neural pathways, help regulate motor homeostasis, or all of the above. John Basma-jian, in a pioneering work called Muscles Alive, has described this work including the demonstration of conditioning a single motor unit. The feedback appears to potentiate an afferent pathway in a way not possible without it. Within this context, physical and occupational therapists use biofeedback in conjunction with physical hands-on training and stretching techniques (see Fig. 1).


Solitary rectal ulcer syndrome (SRUS) is frequently, but not universally, associated with internal intussusception or full-thickness rectal prolapse. SRUS without full-thickness prolapse usually responds to dietary and biofeedback treatment however, an abdominal procedure is usually indicated if there is associated full-thickness prolapse.

Breathing strategies

Breathing strategies can decrease ventilatory impedance by improving elimination of CO2 and minimizing the mechanical effects of hyperinflation. Many patients who are short of breath have a tendency to take shallow breaths at a rapid rate.16,48 This type of breathing pattern can increase dyspnea, and more importantly, it may escalate the anxiety or panic associated with increasing shortness of breath.24,49 Helping the patient practice and develop a breathing pattern of slow, deep breathing becomes even more significant with the recent evidence that dynamic hyperinflation, with resulting restriction of tidal volume, is the primary contributor to dyspnea during exercise.50-52 As discussed later in this chapter, investigators have shown that patients can change their rate and depth of breathing through biofeedback while exercising.53 Others have suggested that the traditional yoga pranayama technique of 4-4-8 can be modified for COPD patients to a 4-2-7-0 pattern, i.e., a count of 4...