Biofeedback

What is it?

Biofeedback is an alternative medicine treatment that trains the patient to change how the body functions. The main goal of biofeedback is to improve physical, emotional and mental health by allowing the patient to have more control over bodily functions through increased awareness on cause-effect phenomena.

In order to help the patient become aware of the body’s way of signaling tension, biofeedback therapy uses sensitive monitoring equipment. This equipment provides an immediate, visual feedback loop that allows the patient become aware of ongoing activities in the body. These bodily activities would be otherwise not noticeable for the patient (e.g. muscle tension, blood pressure, heart rate, etc.)

Biofeedback sensor

The Association for Applied Psychophysiology and Biofeedback suggests “the presentation of this information – often in conjunction with changes in thinking, emotions, and behavior – supports desired physiological changes. Over time, these changes can ensure without continued use of an instrument.”

There are many different types of biofeedback. The specific type to utilize depends upon the goal and what a therapist or a physician recommends. Some of the available options include:

  • Breathing: respiratory biofeedback involves wearing sensor bands around the chest and abdomen to monitor breathing rates and patterns. With training, people can learn to have greater control over their breathing rates.
  • Heart rate: Patients wear a device connected to sensors in either the ears or fingers or sensors placed on the wrists, chest, or torso. It might be useful for a number of different disorders, including asthma and depression.
  • Galvanic skin response: involves measuring the amount of sweat on the surface of the skin and it is a useful marker for detecting levels of emotional arousal.
  • Blood pressure: involves wearing a device that measures blood pressure. These devices provide information about the patient’s blood pressure and often guide the user through relaxation techniques that include visual cues, breathing or music.
  • Skin temperature: patients wear sensors that detect blood flow to the skin. Because people often experience a drop in body temperature in times of stress, these devices can help people better detect when they are starting to feel distressed.
  • Brain waves: often referred to as neurofeedback, involves utilizing electroencephalography (EEG) to measure brain wave activity. Uses of neurofeedback include ADHD, pain, addiction, anxiety, depression and other disorders.
  • Muscle tension: sensors are placed at various points on the body and connected to an electromyography (EMG) device. This device detects changes in muscle tension over time by monitoring electrical activity that results in muscle contractions.

Core philosophy

Biofeedback is based on the principle of motor learning. R.A. Schimdt defined motor learning as a “set of processes associated with practice of experience leading to relatively permanent changes in capability for producing skilled action.

By providing a continuous feedback mechanism (see below), the patient can alter his “standard” states by continuous training.

Psychology Today explains that biofeedback equipment temporarily augments the person’s neural network system by adding sensors to detect physiological events that might otherwise not be perceived and to display these events in ways that are readily perceived and encoded by sensory neurons. In other words, biofeedback enhances our ability to be aware of events that our normal senses are unable to detect. This allows for neural plasticity that modifies excitation/inhibition responses across the relevant neural networks. This in turn, enables the person to better control their skin temperature, skin conductance, muscle tension and/or brain waves.

An important note on this core principle is that these neural modifications that are learned during biofeedback have similar properties to other learned synaptic changes. Ongoing practice is key to keep them, otherwise they tend to decay.

History

Biofeedback history began with the research of Edmund Jacobson, who developed progressive relaxation techniques in the 1930s and Johann Schultz, who developed autogenic training. Both of these techniques are self-regulatory techniques and they served as basis in research and discovery of biofeedback.

Biofeedback emerged in the 1960s when several scientific, philosophical and social movements were converging. Three key researchers are thought to be the “fathers” of biofeedback: Neil Miller, John Basmanjian and Joe Kamiya. They all contributed to the development of a variety of biofeedback techniques.

Neal Miller conducted behavioral research with animals and he found that animals could be trained to control their internal body systems, such as blood pressure and heart function. John Basmanjian began to study voluntary control over the skeletal muscles. He discovered that with feedback anyone could gain control over a single motor unit within a muscle. Other researchers found that with feedback, animals can be trained to control internal body systems such as blood pressure.

Joe Kamiya investigated the internal world of perception and discovered that individuals could learn (through EEG feedback) to discriminate between brain wave states. Then he discovered that with feedback, individuals could produce specific brain wave states on demand.

While testing phrases designed for physical relaxation during autogenic training, researchers at the Menninger Foundation discovered skin temperature biofeedback. During a testing session, one of the volunteers eliminated a migraine headache when she warmed her hands with autogenics. This led to the research (and subsequent clinical use) of skin temperature biofeedback for migraine headaches.

Biofeedback history progressed from research into clinical practice. Today, biofeedback is a well recognized tool for self-regulation and stress relief. According to Mayo Clinic, biofeedback is a useful complementary modality in treating more than 100 illnesses.

Benefits and uses

Psychologists, sport trainers and different therapists have been using biofeedback for decades. Cleveland Clinic is in the midst of a large study looking at expanding the use of biofeedback to three populations of patients in need – those with coronary artery disease, diabetes and multiple sclerosis. Research continues to mount in favor of using biofeedback to improve these patients’ quality of life.

Though biofeedback have direct benefits to many conditions, biofeedback can help to:

  • Reduce stress, depression, anxiety, PTSD and cravings for drugs or alcohol.
  • Lower the experience of chronic pain, common to many mental issues like depression and eating disorders.
  • Improve sleep quality by reducing hyperarousal and insomnia.
  • Help those with ADHD find a greater ability to focus.
  • Improve the benefits of other treatment methods.
  • Aid those not being helped by medication.
  • Encourage empowerment and autonomy.

Who practices it

Most biofeedback practitioners are professionals who enter the biofeedback field as coaches, doctors, nurses, psychologists, teachers or therapists. People interested in the field must have at least a bachelor degree.

With a professional foundation, an aspiring practitioner must earn biofeedback certification from the Biofeedback Certification International Alliance, a nonprofit organization. BCIA certification is critical because three major international biofeedback organizations recognize BCIA’s credentials, including:

BCIA bases its certification on scientific evidence, scientific standards and ethical principles. The BCIA only accepts individuals who meet certain education and training standards and recertifies only those candidates who participate in three hours of continuing education in ethics. Because of the evolving nature of biofeedback science, the BCIA continuously revises its certification exam.

The BCIA does not recognize or encourage the use of the title “biofeedback therapist” because biofeedback is a set of intervention techniques within a practitioner’s primary field. For instance, a psychologist might use biofeedback techniques to help a patient control depression, or a cardiologist might train a patient in biofeedback techniques to maintain proper blood pressure.

BCIA offers three levels of certification for academic and performance professionals, clinicians and technicians:

Entry Level Certification

Open to professionals who hold a bachelor of arts or science degree from an accredited school in health care and who have less than five years of biofeedback experience. Candidates who meet the prerequisites can complete a set of mandatory courses and take an exam.

Certification by Prior Experience

BCIA offers certification by prior experience credentials to health care professionals with at least five years of experience in biofeedback and extensive education and training. To qualify, the professional must hold a credential or license to practice in chiropractic, counseling, dental hygiene, medicine, nursing, occupational therapy, rehabilitation, social work or sports medicine.

The professional must also have completed at least 100 hours of post-professional education from an accredited school and 3,000 patient hours of biofeedback experience over a period of five years. In addition, the professional must have completed 25 hours of mentoring and a validation exam.

Entry-Level Neurofeedback Certification

BCIA’s entry-level neurofeedback certification program is available to people who do not have a health-related degree but work for a licensed, BCIA-certified biofeedback professional. To qualify for a certification, the professional must complete a neuroanatomy, neurophysiology or physiological psychology course offered by an accredited school. In addition, the professional must complete 36 hours of didactic education and 25 hours of mentoring.

What to expect

For people who try biofeedback, some preparation is helpful. This preparation can involve:

  • Reading about biofeedback (particularly the type of biofeedback you will be getting), so that the user has a general concept of the process before it starts.
  • Being motivated to spend the time and effort to complete the course of biofeedback.

Generally, if the user’s doctor refers to a therapist for biofeedback, the therapist will contact the doctor to discuss medical history and healthy problems before therapy begins. If the doctor has not referred to a biofeedback therapist, it is a good idea to check with the doctor first and hear his/her thoughts about biofeedback as a treatment for the specific health problem.

Biofeedback requires motivation, time, effort, practice and honest communication with the therapist. The therapist will discuss symptoms and expectations, medical history, current medications, the results the patient hopes to achieve and the results the patient can expect. The therapist will then introduce the biofeedback equipment to the patient and will connect the patient to the device(s).

Biofeedback session

The sensors will detect the body’s responses. The type of sensor varies according to the type of process being measured. For example, for muscle biofeedback, the patient may have sensors attached to muscles on the head, neck and jaw. For temperature biofeedback, the sensors may be attached to the fingertips or toes. As the patient learns to control the body’s functions, some of which are unconscious, the biofeedback equipment will signal progress with a tone, flashing light or change in pattern on a video screen.

The number of sessions needed varies. At the end of each session, the therapist will review progress and will outline a practice schedule to follow at home. Consistent practice will help remember the training and reinforce it. Once the patient finishes the biofeedback session, he/she can return to the therapist’s office whenever needed.

Interesting facts

Biofeedback is practice that has proven effective on many fronts and that has gained popularity in the last decades. Below are some interesting facts about this practice:

  • Biofeedback can help treat a wide variety of conditions, from general stress and muscle tension to drug/alcohol addiction and chronic migraines, to name a few.
  • Biofeedback is safe and painless.
  • With the help of biofeedback technician, the patient’s physical responses are recorded during an evaluation period.
  • Most patients are not aware of the physical and neurological responses their bodies generate on a daily basis until the see this information.
  • Addition can alter normal brainwave patterns. Using neurofeedback techniques, patients can retrain these over time.
  • Many people report a newfound confidence after learning that they can control aspects of their physical reactions to stress.

Closing statement

Biofeedback therapy is an emerging therapy process in the treatment of physical ailments as well as mental health. Though the technology has existed for some time, its efficacy in treating ailments is becoming a popular conversation among professionals. 

Combining cutting edge technologies like fMRI and EEG, biofeedback essentially helps patients bear witness to their own brainwaves. Looking at how the brain reacts to triggering stimuli, clients understand what happens in their brains without using coping tools. Then, the patients use coping techniques like deep breathing witness how the brain waves calm. The process of biofeedback helps patients gain more control over themselves and their lives.