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Therapies

biofeedback

 

What Is It?
How Does It Work?
What You Can Expect
Health Benefits
How To Choose a Practitioner
Cautions
References

Evidence Based Rating Scale
 

 

What Is It?

Biofeedback is a mind-body technique in which a practitioner uses a special monitoring machine to teach people how to control bodily functions, such as heart rate, blood pressure, skin temperature, and muscle tension, in order to improve their health and well-being.

The first important studies on biofeedback were conducted in the late 1960s by Barbara Brown, of the Veterans Administration Hospital in Sepulveda, California, and Elmer and Alyce Green of the Menninger Foundation, a clinical and research center for mental illness in Topeka, Kansas. Prior to these studies, it was thought that the body's autonomic functions--heart rate, digestion, blood pressure, brain waves, and muscle behavior, for example--could not be voluntarily controlled. The researchers' studies of Indian yogi masters showed that the nervous system and metabolic rate could be consciously regulated. Their work led to an exploration of the use of biofeedback for a wide range of physical ailments, including migraine headaches, insomnia, and circulatory and gastrointestinal disorders.

How Does It Work?

 

During biofeedback, the therapist uses electronic equipment to help you understand how your body responds physiologically to various situations--to stress, pain, or other conditions. The therapist will also teach you relaxation techniques, such as guided imagery and progressive muscle relaxation, to provide a way to actively control these bodily responses.

While biofeedback is known to be quite effective for stress, it differs from other stress-reduction techniques in that it focuses on a particular stress response--tension in the neck and shoulders, for example, or variations in breathing patterns--rather than on relaxing the whole body. With help from the therapist, you learn to control the actions of your nervous system during and after times of stress.

The therapy has also shown promise for ailments such as diabetes and incontinence that may not be stress related. For such conditions you might be taught to increase blood circulation to a specific part of your body or to control a very particular muscle group.  

What You Can Expect

 

During a biofeedback session, you will sit comfortably in a quiet room. The therapist may tape sensors to your forehead or arm to measure the amount of tension in your muscles. You might also have a heat sensor taped to a finger (as you relax, your finger grows warmer). A small machine wired to the sensors then measures responses such as muscle tension, skin temperature, heart rate, and breathing, and translates them into audio or visual signals. You can then use a relaxation technique the therapist has taught you to modulate the signal, which is typically a series of beeps, a flashing light, or a changing image on a computer screen.

By paying attention to the "feedback" from the monitoring machine you can tell how well you are progressing with the therapy. When you make the "correct" response--by relaxing your tense jaw, for instance--you get positive feedback from the machine: The light stops flashing, the beeping stops, or the image on the computer screen changes from an angry face to a happy one. Once you learn to adjust your body's reactions, you'll begin to recognize how the correct (healthier) response feels. The goal is to be able to duplicate this response on your own, without the help of the biofeedback equipment. Like most skills, the more you practice, the more adept you will become at altering the feedback.

Getting hooked up to a biofeedback machine doesn't hurt and is an easy process. You automatically send signals to the machine and it measures them. Most people require between five and 10 sessions to learn how to recognize and control their bodies' responses.

Many health insurance polices now cover biofeedback training to help patients cope with chronic stress-related health problems.

Health Benefits

 

During the past 25 years, research has demonstrated biofeedback's significant health benefits. Studies show that the therapy can help people control headaches caused by muscle contraction or dilated blood vessels better than some conventional treatments (1). Biofeedback is also now being investigated as a cost saving therapy for the treatment of migraine and tension type headaches and has been shown to help people reduce the frequency of their headache from 37 -50%. The therapy may also aid patients recovering from strokes in regaining gait, grip, grasping ability, and other hand functions (2). More research needs to be done on using biofeedback as a rehabilitative therapy for stroke patients; the early research on this topic is still controversial and contradictory (3).

The evidence is convincingly strong for the use of biofeedback as a treatment for urinary incontinence. Biofeedback has been shown to help control urinary leakage by strengthening the floors of the pelvic floor (4). In a study of 120 women suffering from urinary incontinence, 91.6% of the group treated with biofeedback showed improvement when using biofeedback with pelvic muscle training (5). In a similar study, at home biofeedback and pelvic floor muscle training showed a 68.8% success rate after a one year follow-up (6). The results are very promising for anyone suffering from this disorder as a way to control this disruptive problem and avoid invasive surgery.

Similarly, biofeedback is being investigated as a treatment for training the muscle groups needed to prevent faecal incontinence. Fecal incontinence is a very prevalent condition in the elderly, particularly in assisted living residents. It is estimated that 10% of the community dwelling population over the age of 65, and 50% of nursing home residents in the U.S. suffer from this condition. Preliminary research suggests that biofeedback may be a useful treatment in treating some causes of faecal incontinence in the elderly (7). Another small study showed that biofeedback training was efficacious when combined with educational and exercise training (8). The research in this area is still in its early stages. Larger studies are needed to demonstrate whether biofeedback alone or in concert with other treatment is accepted method of treating faecal incontinence.

Biofeedback has also been studied as a treatment for chronic constipation. This work has yielded promising results. A review of 38 studies on the treatment of chronic constipation using biofeedback showed a 62.4% success rate, leading the study authors to conclude that biofeedback is most likely an efficacious treatment for chronic constipation in adults and in children (9). Biofeedback may also be a useful treatment for chronic constipation in the elderly. Again, success rate with this population is not uniform across the board (10). Therefore, biofeedback should be considered as a treatment option in only some cases of chronic constipation in this group. A health professional may be able to help decide if biofeedback is a viable adjunctive or alternative treatment for your particular case.

Biofeedback is also showing promise in treating persons suffering from conditions such as dyslexia, Attention-Deficit Hyperactivity Disorder (ADHD), and some cases of substance addiction or abuse. A prototype study conducted by researchers at the University of Nottingham found that treating dyslexic adults’ heart rate variability via biofeedback improved naming and reading fluency (11). They suspect that these changes may be due to a shift in the central nervous system from autonomic to parasympathetic functioning. More research is needed before drawing any firm conclusions on using biofeedback to treat dyslexia. Likewise, research on biofeedback for the treatment of ADHD has show that it may work by decreasing slow brain wave activity, while increasing fast brain wave activity. Furthermore, the study showed that children and adults suffering ADHD often showed reduced primary ADHD symptoms (12). Researchers are also now starting to recommend biofeedback as a treatment for childhood and adolescent ADHD based on the evidence based practice guidelines established by the American Academy of Child and Adolescent Psychiatry (13). Researchers are also beginning to investigate biofeedback as a treatment for adolescents who abuse stimulants in response to attention and conduct problems (14).

Biofeedback not only helps control muscle contractions and brain waves, but also helps people regulate their blood pressure. High blood pressure is a very prevalent condition in the U.S. and the first line of treatment is usually drug therapy. However, may of these drugs cause a variety of side effects to include headache, irritability and dizziness. For treatment of mild hypertension biofeedback may be an attractive and side effect free alternative to conventional drug treatment (15-17).

Biofeedback may also help control body temperature, and therefore has been shown to be an affective therapy in the treatment of Raynaud’s disease. This condition is marked by the lack of blood flow to the extremities, causing cold and painful fingers and toes particularly in the winter months. Treatment with biofeedback has been shown to help 67.4% of 313 study participants learn to control their ability to warm their hands (18). Biofeedback may be a useful adjunct treatment or a viable alternative for those who do not wish to undergo conventional drug therapy in the treatment of Raynaud’s disease (19).

Other ailments for which biofeedback may also be useful include complications from diabetes, childhood epilepsy, and erectile dysfunction (20-22).

It is important to note that while biofeedback helps people control bodily functions and change behavior, it can't address deeper emotional and psychological issues that may be involved with stress or chronic pain. If these problems persist, you may want to consider counseling or psychotherapy.

How To Choose a Practitioner

 

Most biofeedback therapists are licensed physicians, clinical psychologists, or other healthcare professionals who have taken special training in this technique. The Biofeedback Certification Institute of America in Wheat Ridge, Colorado, provides the major certification program for biofeedback practitioners. Look for a therapist who has experience treating the particular problem for which you are seeking help, and choose someone you feel comfortable with. Remember that the success of the treatment will depend in part on the level of trust you are able to develop with your therapist. Your primary-care physician also may be able to give you a referral to a biofeedback therapist. Many health insurance plans now provide partial coverage for biofeedback therapy.

Cautions

 

·  If you wear a pacemaker or have a serious heart disorder, consult your doctor before undertaking biofeedback.

·  Biofeedback can help people with diabetes control their circulation but it could also change the need for insulin and other medicines. Be sure to monitor blood sugar carefully if you are using this therapy.

·  Biofeedback devices sold for home use vary widely in quality. Ask a physician or biofeedback therapist for advice about a good brand before making a purchase.

References

 

  1. Penzien DB, Rains JC, Lipchik GL, Creer TL. Behavioral interventions for tension-type headache: overview of current therapies and recommendation for a self-management model for chronic headache. Curr Pain Headache Rep. 2004 Dec;8(6):489-99.
  2. Piron L, Tonin P, Atzori AM, Zucconi C, Massaro C, Trivello E, Dam M. The augmented-feedback rehabilitation technique facilitates the arm motorrecovery in patients after a recent stroke. Stud Health Technol Inform. 2003;94:265-7.
  3. Van Peppen RP, Kwakkel G, Wood-Dauphinee S, Hendriks HJ, Van der Wees PJ, Dekker J. The impact of physical therapy on functional outcomes after stroke: what's the evidence? Clin Rehabil. 2004 Dec;18(8):833-62.
  4. Aukee P, Immonen P, Laaksonen DE, Laippala P, Pettinen J, Airaksinen O. The Effect of Home Biofeedback Training on Stress Incontinence. Obstet  Gynecol Surv. 2005 Feb;60(2):95-96.
  5. Seo JT, Yoon H, Kim YH. A randomized prospective study comparing new vaginal cone and FES-Biofeedback. Yonsei Med J. 2004 Oct 31;45(5):879-84.
  6. Aukee P, Immonen P, Laaksonen DE, Laippala P, Penttinen J, Airaksinen O. The effect of home biofeedback training on stress incontinence. Acta ObstetGynecol Scand. 2004 Oct;83(10):973-7.
  7. Wald A. Faecal incontinence in the elderly : epidemiology and management. Drugs Aging. 2005;22(2):131-9.
  8. Ilnyckyj A, Fachnie E, Tougas G. A randomized-controlled trial comparing an educational intervention alone vs education and biofeedback in the management of faecal incontinence in women. Neurogastroenterol Motil. 2005 Feb;17(1):58-63.
  9. Palsson OS, Heymen S, Whitehead WE. Biofeedback treatment for functional anorectal disorders: a comprehensive efficacy review. Appl Psychophysiol Biofeedback. 2004 Sep;29(3):153-74.
  10. Bosshard W, Dreher R, Schnegg JF, Bula CJ. The treatment of chronic constipation in elderly people: an update. Drugs Aging. 2004;21(14):911-30.
  11. Liddle E, Jackson G, Jackson S. An evaluation of a visual biofeedback intervention in dyslexic adults. Dyslexia. 2005 Feb;11(1):61-77.
  12. Butnik SM. Neurofeedback in adolescents and adults with attention deficit Hyperactivity disorder. J Clin Psychol. 2005 Feb 18; [Epub ahead of print]
  13. Hirshberg LM, Chiu S, Frazier JA. Emerging brain-based interventions for children and adolescents: overview and clinical perspective. Child Adolesc Psychiatr Clin N Am. 2005 Jan;14(1):1-19, v.
  14. Trudeau DL. Applicability of brain wave biofeedback to substance use disorder in adolescents. Child Adolesc Psychiatr Clin N Am. 2005 Jan;14(1):125-36, vii.
  15. Rau H, Buhrer M, Weitkunat R. Biofeedback of R-wave-to-pulse interval normalizes blood pressure. Appl Psychophysiol Biofeedback. 2003 Mar;28(1):37-46.
  16. Nakao M, Yano E, Nomura S, Kuboki T. Blood pressure-lowering effects of biofeedback treatment in hypertension: a meta-analysis of randomized controlled trials. Hypertens Res. 2003 Jan;26(1):37-46.
  17. Labarthe D, Ayala C. Nondrug interventions in hypertension prevention and control. Cardiol Clin. 2002 May;20(2):249-63. Review.
  18. Middaugh SJ, Haythornthwaite JA, Thompson B, Hill R, Brown KM, Freedman RR, Attanasio V, Jacob RG, Scheier M, Smith EA. The Raynaud's Treatment Study: biofeedback protocols and acquisition of temperature biofeedback skills. Appl Psychophysiol Biofeedback. 2001 Dec;26(4):251-78.
  19. Birger M, Sha'anani R, Pavlotzki F. Biofeedback treatment of Raynaud's disease. Harefuah. 1997 Nov 2;133(9):362-4, 414.
  20. Rice BI. Improving blood flow to the feet. The power of relaxation and biofeedback. Diabetes Self Manag. 2004 Sep-Oct;21(5):28, 30-1.
  21. Walker JE, Kozlowski GP. Neurofeedback treatment of epilepsy. Child Adolesc Psychiatr Clin N Am. 2005 Jan;14(1):163-76, viii.
  22. Dorey G, Speakman M, Feneley R, Swinkels A, Dunn C, Ewings P. Randomised controlled trial of pelvic floor muscle exercises and manometric biofeedback for erectile dysfunction. Br J Gen Pract. 2004 Nov;54(508):819-25.
  23. Shay SS, Johnson LF, Wong RK, et al. Rumination, heartburn, and daytime gastroesophageal reflux. A case study with mechanisms defined and successfully treated with biofeedback therapy. J Clin Gastroenterol. 1986 Apr;8(2):115-26.
  24.  Valori RM, Hallisey MT, Dunn J. Power of oesophageal peristalsis can be controlled voluntarily. Gut. 1991 Mar;32(3):236-9.

Evidence Based Rating Scale   

The Evidence Based Rating Scale is a tool that helps consumers translate the findings of medical research studies with what our clinical advisors have found to be efficacious in their personal practice. This tool is meant to simplify which supplements and therapies demonstrate promise in the treatment of certain conditions. This scale does not take into account any possible interactions with any medication/ condition/ or therapy which you may be currently undertaking. It is therefore advisable to ask your doctor before starting any new treatment regimen.

Condition

Rating

Explanation

 

 

 

  

 

ADHD

 

 

 

  

 

 

 

 

 

Preliminary evidence indicates some benefit, but research is ongoing.

 

 

 

 

  

Asthma

 

 

 

  

 

 

 

 

 

Some evidence of efficacy in children and adults. Safe with little risk of side effects.

 

 

 

 

 

 

 

 

 

Constipation

 

 

 

 

 

 

 

 

 

 

 

 

A review of studies indicates efficacy in adults and children. However, evidence from conflicting trials indicates efficacy in only some elderly patients.

 

 

 

 

 

 

 

 

 

 

Diabetes

 

 

 

 

 

 

 

 

 

 

 

May contribute to lower blood glucose and increased muscle relaxation. Little known side effects. Can be used in conjunction with conventional medications and supplements to lower blood glucose.

 

 

 

 

 

 

 

Fecal incontinence

 

 

 

 

 

 

 

 

Preliminary evidence indicates efficacy. Larger studies are needed to determine efficacy alone or in conjunction with other treatment.

 

 

Fibromyalgia

 

 

Several studies indicate significant decrease in number of tender points, overall pain intensity, and morning stiffness.

 

 Heartburn  

Preliminary evidence 

indicates efficacy

and there is no risk.

More research

is needed to confirm

or refute these

initial findings.

(23-24)

 

High blood pressure

 

 

 

 

 

 

May be of benefit in mild to moderate hypertension. Safe when used in conjunction with other conventional and alternative therapies.

 

 

Migraine

 

 

 

 

Large clinical studies show effectiveness in reducing the frequency and severity of recurrent migraines.

 

Raynaud’s

 

 

Several trials indicate efficacy equal to or above conventional drug therapy.

 

Stress

 

Small trials have shown some efficacy. More research is needed.

 

Urinary incontinence

 

Several studies indicate efficacy in strengthening pelvic floor.

 

 



Date Published: 09/08/2005
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