Imagine having hands so sensitive to cold that each winter they would swell and split open, so that just grabbing a carton of milk out of the refrigerator makes them whiten and throb with pain. Then imagine learning to raise the temperature in your hands so that you could hold the carton of milk and do it without any pain.
This is an example of what biofeedback training is attempting to accomplish for certain medical problems such as ]]>Raynaud's disease]]> , a circulatory disorder that can cause its victims extreme discomfort and debilitation. When looking at studies done so far, it has not been proven to work.
Currently, incomplete but encouraging evidence suggests that biofeedback may indeed offer at least modest benefits for a variety of medical conditions, including ]]>anxiety]]> , ]]>low-back pain]]> , ]]>insomnia]]> , and female stress incontinence. There is mixed evidence as to whether biofeedback helps with ]]>migraine]]> and ]]>tension]]> headaches.
The major advantages of biofeedback are that it is noninvasive, has virtually no side effects, and is effective over the long-term. The major disadvantage for some is that it requires effort, commitment, and involvement on the part of patients.
How Biofeedback Works
Every time you scratch an itch, grab a snack when you're hungry, or use the bathroom when you feel the urge, you are responding to biofeedback cues from your body about your physiologic state.
With biofeedback training, however, you are cued by sensors attached to your body. These sensors measure heart rate, the temperature of your extremities, the muscle tension in specific muscle groups, or, in neurofeedback, the kinds of brain waves you are emitting. This information is conveyed by visual displays or sounds. Using imagery and mental exercises, you learn to control these functions, using the feedback provided by the sensors as a gauge of success. With practice, you can learn to "tune in" without instrumentation, and control these functions at will during ordinary life.
For example, in a biofeedback training session for headache, temperature sensors would be attached first to your hands, then to your feet, and finally to your forehead, if needed. Your goal would be to increase blood flow away from the brain by raising the temperature in your hands and feet and eventually lowering it in your temples. Other sensors might monitor your electrodermal or galvanic skin response, how easily you sweat or get goose bumps, because this affects your ability to alter your skin temperature.
To warm up your hands and feet, you might imagine basking in the sun on a beach while listening to a script like "I feel warm...my hands are growing warm and heavy..." Both the image and the script would be tailored to you personally to evoke a vivid and relaxing mental image. After your training session, you'd be sent home with this script on audiotape and small thermometers to use for your daily practice.
Who Needs to Be Involved With Biofeedback?
Any biofeedback treatment program should involve your primary healthcare provider and relevant specialists, such as urologists, cardiologists, or neurologists. The training is often most effective when integrated with other types of therapy, such as medication or cognitive behavioral therapy.
Neurofeedback, also called EEG feedback, is the most controversial form of biofeedback therapy, largely because so few controlled clinical trials have been able to assess its efficacy. Neurofeedback is the "retraining" of brainwave patterns. Although controversial, it is experiencing a resurgence of interest in the treatment of a variety of disorders, including ]]>depression]]> , ]]>attention-deficit hyperactivity disorder (ADHD)]]> , and ]]>alcoholism]]> .
In a neurofeedback training session, several sensors that measure your brain's electrical activity are attached to your scalp. You relax and play a video game, which is controlled just by your brain waves and responds favorably to brain waves of the desired pattern. As you play the game, your trainer observes your ]]>electroencephalogram (EEG)]]> , transmitted to a separate video terminal. Most practitioners recommend at least 20 sessions to obtain significant, long-lasting results, although improvement is usually noted early on if the treatment protocol is right for you.
A note of caution: Because the field is new, many practitioners have little or no experience beyond a week-long training session, so ask lots of questions and talk with your primary care provider before embarking on a treatment program.
Applied Psychophysiology and Biofeedback
Biofeedback Certification Institute of America
Healthcare Information Resources
Women's Health Matters
Applied Psychophysiology and Biofeedback. Available at: http://www.aapb.org .
Last reviewed February 2010 by ]]>Brian Randall, MD]]>
Copyright © 2007 EBSCO Publishing All rights reserved.