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Introduction |
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Biofeedback is the field of applied psychophysiology, which uses
psychological manipulations to control or regulate physiological responses in
the body. This technique teaches patients how to control certain involuntary
bodily processes, such as heart rate, muscle tension, blood pressure, and skin
temperature, to manage their reactions to stress and to achieve other beneficial
changes in symptoms or behaviors. The involuntary functions are monitored with
electrodes and displayed on a computer monitor; such monitoring provides
feedback to patients as they learn to recognize, respond to, and regulate the
subtle signals associated with these processes (Sabo and Giorgi 2000).
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Historical Background |
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Biofeedback grew out of self-regulatory traditions, such as yoga and
meditation, which have been practiced in Eastern societies for thousands of
years. In the 1960s, researchers became fascinated with yoga masters who could
use meditation under laboratory conditions to control bodily functions at
astounding levels. For example, in one study, Swami Rama, an Indian yogi,
stopped his heart from beating for a full 17 seconds, and then restarted it
without any apparent adverse effects. Clinicians realized that, with the help of
computer-generated feedback, ordinary individuals who were not yogis could also
learn to control some physiological processes by manipulating concrete, visual
data reflecting moment-to-moment physiological responses (Sabo and Giorgi
2000).
Clinical biofeedback originally used simple electronic devices housed in
bulky wooden boxes. With the advent of computer technology in the late 1980s and
1990s, practitioners and researchers have been able to streamline biofeedback
instrumentation and collect and analyze more extensive and precise physiologic
data. As a result, practitioners have expanded the scope of biofeedback's
clinical applications to include a wider variety of medical and psychological
conditions and to promote peak athletic and mental performance states (Sabo and
Giorgi 2000). Today, biofeedback is mainly used for conditions that may be
caused or aggravated by stress, particularly tension and migraine headaches,
chronic pain, and hypertension. |
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Scientific
Principles |
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Biofeedback teaches patients to use a type of intuitive control known as
passive volition to develop greater awareness and regulation of
physiologic processes. The mechanism by which voluntary control is exerted is
not well understood. However, the attention and arousal levels, which are
mediated by the thalamic and reticular activating systems in the brain, seem to
play a key role in regulating involuntary bodily functions (Sabo and Giorgi
2000). |
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Mechanism of Action |
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Any physiologic response that can be monitored is amenable to intervention
via biofeedback techniques. Patients may also use breathing techniques, imagery,
and relaxation methods to facilitate control over their physiologic responses.
Such methods are not absolutely necessary, however, since the learning process
involved seems to be mediated by simple attention to the task. The most common
types of biofeedback techniques include electromyography (EMG), which measures
muscle tension; thermal biofeedback, which measures skin temperature; and
electroencephalography (EEG), which measures brain wave activity (Sabo and
Giorgi 2000). |
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Clinical Evaluation |
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Biofeedback training typically takes place over a series of sessions in the
practitioner's office. Electrodes attached to the patient transmit physiological
data to a computer, which provides visual and/or auditory feedback that is
explained to the patient by the practitioner during training sessions. The
practitioner may also teach various relaxation methods and deep breathing
techniques, coaching the patient on how and when to use these methods (Sabo and
Giorgi 2000). By observing instantaneous changes in muscle tension, temperature,
and/or brain waves, the patient gains an understanding of the physiological
response(s) involved and learns to effect a change in
behavior. |
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Clinical Applications |
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Studies show that various forms of biofeedback are effective for a range of
conditions. For example, the results of a randomized, controlled trial suggest
that biofeedback shows considerable promise for the treatment of urinary
incontinence, which affects over 15 million Americans; biofeedback may thus
offer a less invasive and more widely applicable alternative to medication
(Resnick 1998). An earlier study indicated that biofeedback, by improving
bladder muscle function, reduced the frequency of symptoms in patients with urge
incontinence by an average of 94 percent, in patients with detrusor motor
instability by 85 percent, and in patients with stress incontinence by 82
percent (Burgio et al. 1985). In view of such studies, the Agency for Health
Care Policy and Research has recommended biofeedback therapy as a treatment for
urge, stress, and mixed urinary incontinence (AHCPR 1996).
Another study followed the progress of 100 patients with fecal incontinence
referred for biofeedback training. Overall, 43 of the 100 patients regarded
themselves as cured after treatment, while another 24 improved (Norton and Kamm
1999). Similar results have been reported in the biofeedback treatment of
obstructive defecation as well (Rao 1998).
Research also suggests that vasodilation induced by thermal biofeedback
decreases the frequency of symptoms in those with Raynaud's disease (Freedman
1991). EMG biofeedback has been shown to reduce pain, morning stiffness, and the
number of tender points in patients with fibromyalgia (Leventhal 1999).
Furthermore, a review of the current research on chronic insomnia suggests that
biofeedback may be an effective technique for diminishing the somatic arousal
(e.g., muscle tension) that leads to sleeplessness (Chesson et al. 1999).
In addition, an experimental study of 14 alcoholic outpatients indicates that
the combination of temperature biofeedback and alpha-theta EEG neurofeedback may
help reduce self-assessed symptoms of depression and sustain sobriety in
alcoholics (Saxby and Peniston 1995). Finally, biofeedback can be used
effectively for certain ailments in children. A clinical trial indicates that
EEG training can improve Tests of Variables of Attention (TOVA) performance,
behavioral ratings, and Wechsler intelligence (WISC-R) scores in children with
Attention Deficit/Hyperactivity Disorder (Lubar et al. 1995). Thermal
biofeedback has also been reported to help alleviate migraine and chronic
tension headaches among children and adolescents (Annequin et al. 2000).
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Risks, Side Effects, Adverse
Events |
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Biofeedback is considered a safe procedure; no adverse events are known to
have been reported in the literature to date (Sabo and Giorgi 2000).
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Contraindications |
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No contraindications are known to have been reported in the literature to
date (Sabo and Giorgi 2000). |
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Additional Clinical
Outcomes |
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In addition to the conclusions in the section entitled Clinical Applications,
EEG neurofeedback may be useful for treating anxiety, depression, epilepsy and
related seizure disorders, closed head injuries, learning disabilities,
posttraumatic stress disorder, certain endocrine disorders, autoimmune
disorders, autism, chronic pain, muscle spasms, and multiple chemical
sensitivities. Both thermal and EMG biofeedback have been used to treat
hypertension, and EMG biofeedback may also be helpful for muscle spasms, back
pain, and spinal cord injury (Sabo and Giorgi 2000). |
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The Future |
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Biofeedback offers great promise as a non-invasive therapy for a wide range
of conditions that actively involves the patient as a partner in his or her own
care. Future research is needed to validate its efficacy, establish treatment
protocols, and expand its applications (Sabo and Giorgi
2000). |
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Training, Certification, and
Licensing
Requirements |
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There are many training programs throughout the United States; nurses,
physicians, and psychologists trained in behavioral medicine often become
trained in biofeedback as well. The Biofeedback Certification Institute of
America provides an examination and certification for professional practitioners
(Sabo and Giorgi 2000). In addition, local chapters of such national
organizations as the Association for Applied Psychophysiology and Biofeedback
and the Society for Neuronal Regulation can be found in many
states. |
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Resources |
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For information on referrals to qualified practitioners, third-party
reimbursement, and annual seminars and conferences, contact the Association for
Applied Psychophysiology and Biofeedback in Wheat Ridge, CO at 303-422-8436 or
on the Web at www.aapb.org. The Biofeedback Certification Institute of America
in Wheat Ridge, CO is affiliated with the AAPB; contact the organization at
303-420-2902 or on the Web at www.bcia.org for referrals and information about
the credentialing process for biofeedback training. The Society for Neuronal
Regulation in Merino, CO publishes the Journal of Neurotherapy, keeps the
biofeedback community informed of current research, and sponsors several
training programs for practitioners at its annual conferences. Contact the
society at 800-488-3867 or on the Web at www.snr-jnt.org. |
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References |
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AHCPR. Clinical Practice Guideline Number 2: Urinary incontinence in
adults: acute and chronic management. Rockville, MD: Agency for Health Care
Policy and Research, US Dept of Health and Human Services; 1996. AHCPR
publication 96-0682.
Annequin D, Tourniaire B, Massiou H. Migraine and headache in childhood and
adolescence. Pediatr Clin North Am. 2000;47(3):617-631.
Burgio KL, Whitehead WE, Engel BT. Urinary incontinence in the elderly.
Bladder-sphincter biofeedback and toileting skills training. Ann Intern
Med. 1985;103(4):507-515.
Chesson AL, Anderson WM, Littner M, et al. Practice parameters for the
nonpharmacological treatment of chronic insomnia. Sleep.
1999;22(8):1128-1133.
Freedman RR. Physiological mechanisms of temperature biofeedback.
Biofeedback Self Regul. 1991;16(2):95-115.
Leventhal LJ. Management of fibromyalgia. Ann Intern Med.
1999;131:850-858.
Lubar JF, Swartwood MO, Swartwood JN, O'Donnell PH. Evaluation of the
effectiveness of EEG neurofeedback training for ADHD in a clinical setting as
measured by changes in T.O.V.A. scores, behavioral ratings, and WISC-R
performance. Biofeedback Self Regul. 1995;20(1):83-99.
Norton C, Kamm MA. Outcome of biofeedback for faecal incontinence. Br J
Surg. 1999;86(9):1159-1163.
Rao SS. The technical aspects of biofeedback therapy for defecation
disorders. Gastroenterologist. 1998;6(2):96-103.
Resnick NM. Improving treatment of urinary incontinence. JAMA.
1998;280(23):2034-2035.
Sabo MJ, Giorgi J. Biofeedback. In: Novey DW, ed. Clinician's Complete
Reference to Complementary and Alternative Medicine. St. Louis, Mo: Mosby;
2000:32-40.
Saxby E, Peniston EG. Alpha-theta brainwave neurofeedback training: an
effective treatment for male and female alcoholics with depressive symptoms.
J Clin Psychol.
1995;51(5):685-693. |
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Copyright © 2000 Integrative Medicine
Communications This publication contains
information relating to general principles
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instructions for individual patients. The publisher does not accept any
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