Like grocery stores stocking organic food and fitness fans flocking to yoga, medicine is going back to the future—with biofeedback.
Biofeedback uses modern technology combined with meditation and relaxation to provide real-time information about automatic processes in our bodies—such as heart rate or brain waves—that we normally are not aware of. It converts this information into sound or a picture that a patient can use to regulate her body. Eventually the patient learns to use her mind, thoughts, and emotions to alter her biological process. This puts the patient in control of her body. It may also help to reduce or eliminate the need for medication, or treat conditions that don’t respond well to medication. Because it is non-invasive, biofeedback is very safe, with practically no adverse reactions on record.
A typical biofeedback session begins with a detailed patient history and a discussion of treatment goals. The setting is usually a quiet room with soothing light and comfortable seating. A therapist instructs the patient throughout the session to focus on making the desired change. A computer provides feedback in the form of a videogame or musical pitches. Sessions last from 30 to 60 minutes and the number of treatments varies from five to 30 sessions, depending on the complexity of the condition being treated. In between sessions the patient is encouraged to practice the techniques at home to maximize the therapeutic benefit.
There is no license needed to practice biofeedback in the United States. Currently the Biofeedback Certification Institute of America is the only certifying agency for healthcare professionals. It requires supervised clinical hours and a passing score on the certifying examination.
The first clinical use of biofeedback was in the 1960s, for urinary incontinence. Now biofeedback is being used to treat high blood pressure, headaches, chronic pain, stress, heart disease, Raynaud’s disease, constipation, stroke, asthma, and other chronic issues.
There are six basic forms of biofeedback. All of them can lead to a path of self discovery by uncovering the power that our thoughts and emotions have over our health.
Electromyography (EMG) uses electrodes to measure and provide feedback of muscle tension. It has been used to treat back pain, tension headaches, jaw pain, joint pain, and blood pressure.
Electroencephalography (EEG) measures brain waves. Different frequencies of brain wave activity are associated with mental states such as light or deep sleep, concentration, wakefulness, and relaxation. It is used to treat anxiety, attention deficit hyperactivity disorder, insomnia, epilepsy and addiction.
Heart-rate-variability biofeedback measures small beat-to-beat changes of the heart rhythm. The variability can be altered by deep breathing or emotional states, and it is theorized to be an indirect measurement of the “autonomic” nervous system, which controls processes in our visceral organs and blood vessels that are not under our voluntary control. This kind of biofeedback is used to treat cardiovascular disease, stress, pain, headaches, and blood pressure.
Thermal biofeedback uses a sensor to measure skin temperature. The temperature fluctuates with emotional states such as stress or relaxation. This is another indirect measure of the autonomic nervous system, and it is used to treat headaches, blood pressure, stress, anxiety, pain, and Raynaud’s disease.
Glavanic skin response is an indirect measure of the autonomic nervous system that monitors sweat gland activity. It is used for anxiety, emotional disorders, blood pressure, and pain.
Slow controlled breathing biofeedback is used to treat blood pressure and for relaxation. It regulates heart rate variability and the autonomic nervous system.
Prior to the modern era of medicine, our mind and thoughts were inseparable from our body. This interconnectedness was observed by many cultures and played a central role in the diagnosis and treatment of ailments. In western medicine, as science and technology rapidly advanced, our mind was perceived as separate from the rest of our body in the diagnosis and treatment of disease.
Science requires quantifiable observations and reproducible experiments. Thoughts and feelings are difficult, if not impossible, to measure and thus they were discarded as irrelevant. In contrast, medical and surgical diagnosis and treatment outcomes are easy to record and measure.
Biofeedback is difficult to study because of the variability of how it is administered. Still, the medical literature over the past several decades has been accumulating with some favorable results. Although most of the studies are small, there are enough of them to be statistically evaluated in meta-analyses. This is a way to group several studies together to see if there is an overall trend or common outcome.
A meta-analysis in the Journal of Pain found strong evidence of the effectiveness of biofeedback as a treatment for migraine headaches. It examined 55 studies with a total of 2,229 patients. The authors concluded that biofeedback can be used to prevent migraines. Specifically, they found that the frequency and duration of headaches were reduced more than with medication- intake and that it reduced anxiety and depression. This suggests a prophylactic potential of biofeedback. These effects were not only immediate but were maintained and somewhat enhanced over time.
The literature of biofeedback’s effectiveness in treating chronic back pain is mixed, although a recent study by Flor found that biofeedback reduced pain, interference with activities of daily life, distress, and health care use. Biofeedback is also being studied as part of the treatment of fibromyalgia. Fibromyalgia is a syndrome of widespread pain that usually affects women between 20-60 years of age. Several small studies have found a reduction in the number of tender points, pain intensity, morning stiffness, and depression.
Biofeedback has been studied more extensively for the treatment of high blood pressure than for any other cardiac condition. Yucha’s 2001 review of 23 randomized control trials found that biofeedback lowered systolic blood pressure by 6.7 mm Hg and diastolic by 4.8 mm Hg. Nakao’s 2003 review of 22 randomized controlled trials also found similar reductions in blood pressure, and Kranitiz’s review in 2004 found that in general larger and more consistent blood pressure lowering effects have been observed in biofeedback therapies that involve slow controlled breathing guidance.
The relaxation techniques used while performing biofeedback are similar to those commonly used in Eastern disciplines. They involve slow, controlled breathing with a focus on a mantra or on various parts of one’s body. Extensive research by Lehrer and Vaschillo found that slow breathing between three and nine times a minute can increase heart-rate variability, which is a reflection of a balance of the autonomic nervous system. This increase in heart-rate variability has been shown to decrease anxiety and ease depression as well as lower blood pressure.
Although these relaxation techniques can be done without biofeedback, the use of a biofeedback machine helps to individualize the techniques. The machine helps the patient achieve the correct breathing rate and guides them to the most efficient way to mentally relax.
Biofeedback is a form of mind-body medicine that has its roots in meditation and relaxation techniques, but uses modern scientific instrumentation to help guide a person to a desired state of balanced mind and body. Studies overwhelmingly conclude that it is safe. It empowers patients to take a more active role in treating disease and maintaining health and can lead to a path of self-discovery by uncovering the power that our thoughts and emotions have over our body.
Web Resources
www.mayoclinic.com/health/biofeedback/SA00083
www.bcia.org
www.aapb.org
