Biofeedback; Treatment.

Biofeedback typically involves a series of sessions over several weeks. The length and number of sessions you need will depend on your condition and how fast you can learn to control your physical responses. Some conditions require as few as three or four sessions, especially for children, while others require 10 to 15. Electroencephalographic (EEG) biofeedback--which measures, displays and teaches you to control brainwaves--can take longer. Some conditions may require 40 or 50 EEG sessions in the clinic. You and your biofeedback therapist will come up with a schedule that's right for your condition.

You can expect a session to last from 30 minutes to an hour. (Your first one may take longer as the therapist explains the process to you.)

The biofeedback therapist will first explain the process to you and show you the various pieces of equipment. You'll sit in a comfortable chair, and the therapist will apply sensors to various points on your body (most typically, the shoulders, fingers, back and/or head) depending on your complaint and the protocol developed to bring about beneficial change. This may vary among clinics. For instance, if you have headaches or insomnia, the sensors will probably be placed on your scalp.

The sensors are connected to equipment that provides instantaneous feedback on the function you are trying to control. What's this feedback like? It varies. Some machines show you the changes on a computer monitor. Others beep or buzz or blink or otherwise indicate fluctuations in the function you are targeting.

Before the training begins, the biofeedback professional will take a baseline reading to find what your "normal" state is; this makes it possible to gauge changes.

Next, the therapist will guide you through various mental or physical exercises that are designed to bring about the desired biological changes--exercises that can help you control a particular function. And by paying attention to the feedback, you'll learn to associate certain thoughts and actions with the desired change in your previously involuntary responses. Sensors are attached to your body to monitor certain physical processes such as temperature, heart rate and muscle tension, for example. This information is fed back by electronic signals, which help to speed the learning process so that you know immediately if the desired effect has been achieved.

For instance, you may be connected to a device that indicates muscle tension via an electronic signal. This signal increases as you tense and decreases as you relax. This approach is particularly helpful to women with incontinence. It raises awareness of and control over pelvic floor muscles. By using electronic devices to gauge bladder and urethral muscle contractions, you can learn to control and strengthen these muscles. Sometimes the pelvic floor muscles are strong but are spastic or in spasm and need to be retrained so they relax appropriately.

Your therapist will serve as a coach who guides and encourages you in various relaxation techniques, self-regulation, self-awareness and home practices. By practicing these techniques, you gain greater control over your bodily functions. Once you gain competence practicing at the clinic, the idea is to become so good that you no longer need to be monitored by the instrumentation or a therapist.

In some clinics you are first taught to close your eyes and focus inward to listen to bodily changes. After you're familiar with the technique, you are taught to open you eyes and focus on the sounds, lights or computer display to help fine-tune skills learned with your eyes closed.

Gradually, you'll be able to do this without the audio or visual aids. Just by concentration, you can contract and/or relax certain muscles. At that point, you can use biofeedback on your own, without the equipment and guidance of a clinic session.

There are several basic methods and instruments:

Electromyography (EMG) measures muscle activity. This approach is used for a number of conditions, including muscle stiffness, stress incontinence, urge incontinence, overflow incontinence, urinary urgency and frequency, headaches, tooth grinding, stress, and chronic pain. It's also used when muscles are healing or being reconditioned. Sensors are usually attached to the affected muscles.

Thermal biofeedback provides information about skin temperature, an indication of blood flow. You might take this approach if you suffer from migraines, Raynaud's disease, anxiety or high blood pressure. Sensors often go on your fingers or feet.

Galvanic skin response training measures changes in your skin's surface--particularly perspiration rates. This is a common method for dealing with stress, phobias and stuttering.

Electrocardiographs (ECGs) monitor the heart rate and are used to address high blood pressure, heartbeat irregularities and anxiety. Sensors are placed on your fingers or your wrist.

Respiration (rate, rhythm and type of breathing) can be monitored--often through a strain gauge wrapped around your chest or waist. This method is often used for asthma, hyperventilation, anxiety, panic and angina with chest pain.

Electroencephalographs (EEG) measure brainwaves. Ideally, an EEG will help you learn how to recognize and modify your brainwave activity by identifying certain brainwave patterns. EEG biofeedback (also called neurotherapy) can help improve attention and reduce impulsivity and is used to treat attention deficit hyperactivity disorder, head injuries and mild depression. It also has been used to treat epilepsy and depression and to promote recovery from head injuries and stroke. Sensors are placed on the head in various locations dependent on the treatment.

Heart Rate Variability (HRV) is being utilized to provide an opportunity to observe the heart's ability to respond to normal regulatory impulses that affect its rhythm. The assumption is that a beat-to-beat fluctuation in the rhythm of the heart provides therapist with an indirect measure of heart health. The Heart and Stroke Foundation of Canada and the Biofeedback Foundation of Europe have provided grant monies to see if control of HRV can help in smoking cessation. HRV technology and techniques also are being used to reduce stress and improve employee and patient well-being in hospitals; to reduce test anxiety among students; and even to improve athletic performance.

In addition to the actual biofeedback, your therapist will probably work with you on relaxation exercises, stress-coping techniques, deep breathing and muscle relaxation.

Many people learn to control various functions, including heart rate, blood pressure and muscle tension. (This ability enables some people to go off certain medications, such as those for blood pressure and mild depression. But don't make this decision alone: Talk to the prescribing health care professional before discontinuing any drug regimen.)

Biofeedback success rates vary widely based on the individual and the condition. There have been numerous published studies on the efficacy of biofeedback; however, researchers may want to do further studies. The practice is increasingly gaining mainstream acceptance with more complex conditions.

References

HeartMath LLC. Available at http://www.heartmath.com. Accessed April 2008.

"Biofeedback: Using your mind to improve your health." The Mayo Clinic. January 25, 2008. http://www.mayoclinic.com. Accessed February 2008.

"Biofeedback." The University of Maryland Medical Center. 2007. http://www.umm.edu. Accessed February 2008.

"Biofeedback certification." The Biofeedback Certification Institute of America. http://www.bcia.org. Accessed February 2008.

"Past speakers 05-06 Season." The Foundation for Mind Being Research. http://www.fmbr.org. Accessed February 2008.

"Biofeedback." Biofeedback Certification Institute of America. http://www.bcia.org. Accessed May 2000.

"Integration of Behavioral and Relaxation Approaches Into The Treatment of Chronic Pain and Insomnia." National Institutes of Health Technology Assessment Conference Statement (1995). http://text.nlm.nih.gov. Accessed May 2000.

"Biofeedback." The Association for Applied Psychophysiology and Biofeedback. http://www.aapb.org and http://www.aapb.org. Accessed September 2001.

Capps, S. "Biofeedback." Lecture. Psychology Department at Southwest Missouri State University. http://aloha.smsu.edu. Accessed May 2000.

"What is Biofeedback?" The BioResearch Institute. http://www.7hz.com. Accessed May 2000.

Biofeedback Foundation of Europe: http://www.bfe.org

Keywords: biofeedback, eeg, feedback, muscle tension, heart rate, raynaudINVALID_CHARACTERs disease