Biofeedback

Biofeedback is a treatment technique in which people are trained to improve their health by using signals from their own bodies. Physical therapists use biofeedback to help stroke victims regain movement in paralyzed muscles. Psychologists use it to help tense and anxious clients learn to relax. Specialists in many different fields use biofeedback to help their patients cope with pain.

Therapists reply on biofeedback machines in somewhat the same way that you rely on your scale or thermometer. Their machines can detect a person's internal bodily functions with far greater sensitivity and precision than a person can alone. This information may be valuable. Both patients and therapists use it to gauge and direct the progress of treatment.

For patients, the biofeedback machine acts as a kind of sixth sense which allows them to "see" or "hear" activity inside their bodies. One commonly used type of machine, for example, picks up electrical signals in the muscles. It translates these signals into a form that patients can detect: It triggers a flashing light bulb, perhaps, or activates a beeper every time muscles grow more tense. If patients want to relax tense muscles, they try to slow down the flashing or beeping.

Like a pitcher learning to throw a ball across a home plate, the biofeedback trainee, in an attempt to improve a skill, monitors the performance. When a pitch is off the mark, the ballplayer adjusts the delivery so that he performs better the next time he tries. When the light flashes or the beeper beeps too often, the biofeedback trainee makes internal adjustments which alter the signals. The biofeedback therapist acts as a coach, standing at the sidelines setting goals and limits on what to expect and giving hints on how to improve performance.

The word "biofeedback" was coined in the late 1960s to describe laboratory procedures then being used to train experimental research subjects to alter brain activity, blood pressure, heart rate, and other bodily functions that normally are not controlled voluntarily. At the time, many scientists looked forward to the day when biofeedback would give us a major degree of control over our bodies. They thought, for instance, that we might be able to "will" ourselves to be more creative by changing the patterns of our brainwaves. Some believed that biofeedback would one day make it possible to do away with drug treatments that often cause uncomfortable side effects in patients with high blood pressure and other serious conditions.

Today, most scientists agree that such high hopes were not realistic. Research has demonstrated that biofeedback can help in the treatment of many diseases and painful conditions. It has shown that we have more control over so-called involuntary bodily function than we once though possible. But it has also shown that nature limits the extent of such control. Scientists are now trying to determine just how much voluntary control we can exert.

Clinical biofeedback techniques that grew out of the early laboratory procedures are now widely used to treat an ever-lengthening list of conditions.

Biofeedback can be used by coaches and educators to help people function better and by therapists as part of treatment for many disorders including anxiety, urinary incontinence, fecal incontinence and constipation, migraine headaches, tension headaches, ADHD, ADD,   pain from improperly functioning muscles in the jaws, shoulders, back, etc., irritable bowel syndrome, phobias, non-cardiac chest pain, high and low blood pressure, epilepsy, paralysis and other movement disorders, stress, and many other types of problems.

Specialists who provide biofeedback training range from psychiatrists and psychologists to dentists, internists, nurses, physical therapists, and other mental health professionals.  Most psychotherapists rely on many other techniques in addition to biofeedback. Patients usually are taught some form of relaxation exercise. Some learn to identify the circumstances that trigger their symptoms. They may also be taught how to avoid or cope with these stressful events. Most are encouraged to change their habits, and some are trained in special techniques for gaining such self-control. Biofeedback is not magic. It cannot cure disease or by itself make a person healthy. It is a tool, one of many available to health care professionals. It reminds physicians that behavior, thoughts, and feelings profoundly influence physical health. And it helps both patients and doctors understand that they must work together as a team.

Biofeedback places unusual demands on patients. They must examine their day-to-day lives to learn if they may be contributing to their own distress. They must recognize that they can, by their own efforts, remedy some physical ailments. They must commit themselves to practicing biofeedback or relaxation exercises every day. They must change bad habits, even ease up on some good ones. Most important, they must accept much of the responsibility for maintaining their own health.

Scientists cannot yet explain how biofeedback works. Most patients who benefit from biofeedback are trained to relax and modify their behavior. Most scientists believe that relaxation is a key component in biofeedback treatment of many disorders, particularly those brought on or made worse by stress. Their reasoning is based on what is known about the effects of stress on the body. In brief, the argument goes like this: Stressful events produce strong emotions, which arouse certain physical responses. Many of these responses are controlled by the sympathetic nervous system, the network of nerve tissues that helps prepare the body to meet emergencies by "flight or fight."

The typical pattern of response to emergencies probably emerged during the time when all humans faced mostly physical threats. Although the "threats" we now live with are seldom physical, the body reacts as if they were: The pupils dilate to let in more light. Sweat pours out, reducing the chance of skin cuts. Blood vessels near the skin contract to reduce bleeding, while those in the brain and muscles dilate to increase the oxygen supply. The gastrointestinal tract, including the stomach and intestines, slows down to reduce the energy expensed in digestion. The heart beats faster, and blood pressure rises. Normally, people calm down when a stressful event is over especially if they have done something to cope with it. For instance, imagine your own reactions if you're walking down a dark street and hear someone running toward you. You get scared. Your body prepared you to ward off an attacker or run fast enough to get away. When you do escape, you gradually relax.

If you get angry at your boss, it's a different matter. Your body may prepare to fight. But since you want to keep your job, you try to ignore the angry feelings. Similarly, if on the way home you get stalled in traffic, there's nothing you can do to get away. These situations can literally may you sick. Your body has prepared for action, but you cannot act. Individuals differ in the way they respond to stress. In some, one function, such as blood pressure, becomes more active while others remain normal. Many experts believe that these individual physical responses to stress can become habitual. When the body is repeatedly aroused, one or more functions may become permanently overactive. Actual damage to bodily tissues may eventually result.

Biofeedback is often aimed at changing habitual reactions to stress that can cause pain or disease. Many clinicians believe that some of their patients and clients have forgotten how to relax. Feedback of physical responses such as skin temperature and muscle tension provides information to help patients recognize a relaxed state. The feedback signal may also act as a kind of reward for reducing tension. It's like a piano teacher whose frown turns to a smile when a young musician finally plays a tune properly.

The value of a feedback signal as information and reward may be even greater in the treatment of patients with paralyzed or spastic muscles. With these patients, biofeedback seems to be primarily a form of skill training like learning to pitch a ball. Instead of watching the ball, the patient watches the machine, which monitors activity in the affected muscle. Stroke victims with paralyzed arms and legs, for example, see that some part of their affected limbs remains active. The signal from the biofeedback machine proves it. This signal can guide the exercises that help patients regain use of their limbs. Perhaps just as important, the feedback convinces patients that the limbs are still alive. This reassurance often encourages them to continue their efforts.

If you think you might benefit from biofeedback training, you should discuss it with your physician or other health care professional, who may wish to conduct tests to make certain that your condition does not require conventional medical treatment first. Responsible biofeedback therapists will not treat you for headaches, hypertension, or most disorders until you have had a thorough physical examination. Some require neurological tests as well.

How do you find a biofeedback therapist? First, contact the nearest community health center, medical society, state psychological association or State biofeedback society for a referral. The psychology or psychiatry departments at nearby universities may also be able to help you. Most experts recommend that you consult only a health care professional a physician, psychologist, psychiatrist, nurse, social worker, dentist, physical therapist, for example who has been trained to use biofeedback.

The Association for Applied Psychophysiology and Biofeedback (formerly the Biofeedback Society of America) (AAPB) is the national membership association for professionals using biofeedback. The Biofeedback Certification Institute of America (BCIA) was established as an independent agency to provide national certification for biofeedback providers.

The above information was adapted from material provided through the U.S. Department of Health and Human Services Division of Communications and Education, National Institute of Mental Health, Alcohol, Drug Abuse and Mental Health Administration.

Wikipedia provides the following information on biofeedback:

Biofeedback is a form of complementary and alternative medicine (CAM) which involves measuring a subject's bodily processes such as blood pressure, heart rate, skin temperature, galvanic skin response (sweating), and muscle tension and conveying such information to him or her in real-time in order to raise his or her awareness and conscious control of the related physiological activities.

By providing access to physiological information about which the user is generally unaware, biofeedback allows users to gain control over physical processes previously considered automatic.

Interest in biofeedback has waxed and waned since its inception in the 1960s; at the beginning of the 21st century it is undergoing something of a renaissance, which some ascribe to the general upswing of interest in complementary and alternative medicine modalities. Neurofeedback has become a popular treatment for ADHD, electromyogram (muscle tension) biofeedback has been widely studied and accepted as a treatment for incontinence disorders, and small home biofeedback machines are becoming available for a variety of uses. Its role in controlling hypertension is becoming recognized.

Types of Biofeedback Instrumentation

Electromyogram (EMG)
This is the most common form of biofeedback measurement. An EMG uses electrodes or other types of sensors to measure muscle tension. By the EMG alerting you to muscle tension, you can learn to recognize the feeling early on and try to control the tension right away. EMG is mainly used as a relaxation technique to help ease tension in those muscles involved in backaches, headaches, neck pain and grinding your teeth (bruxism). An EMG may be used to treat some illnesses in which the symptoms tend to worsen under stress, such as asthma and ulcers.

Peripheral Skin Temperature
Sensors attached to your fingers or feet measure your skin temperature. Because body temperature often drops when a person experiences stress, a low reading can prompt you to begin relaxation techniques. Temperature biofeedback can help treat certain circulatory disorders, such as Raynaud's disease, or reduce the frequency of migraines. The physiological process behind the temperature drop associated with the stress response is quite simply vasoconstriction (blood vessels narrowed by the smooth musculature in their walls)

Galvanic skin response training
Sensors measure the activity of your sweat glands and the amount of perspiration on your skin, alerting you to anxiety. This information can be useful in treating emotional disorders such as phobias, anxiety and stuttering. This is the method most commonly used by lie detector machines. It is the most popular form of biofeedback, with over 500,000 hand-held GSR2 units having been purchased by consumers since the early 70's; it is also one of the biofeedback methods used by the video game series Journey to Wild Divine.

Electroencephalography (EEG)
An EEG monitors the activity of brain waves linked to different mental states, such as wakefulness, relaxation, calmness, light sleep and deep sleep. This is the least common of the methods, mostly due to the cost and availability of an EEG machine.

Criticisms
Not all of biofeedback's uses are well-accepted in the medical community. While biofeedback is widely accepted as a treatment for incontinence, other uses are still controversial. For instance, while many scientific studies have studied neurofeedback as a treatment for Attention Deficit/Hyperactivity Disorder, it is generally felt that neurofeedback is a "promising" rather than "proven" treatment modality. EEG biofeedback as a treatment for ADHD is viewed with skepticism in some parts. Additionally, some believe that the use of biofeedback for stress and anxiety is an expensive treatment for difficulties which could be addressed with relaxation training, meditation, and self-hypnosis.

Finding a biofeedback therapist: Once you decide to try biofeedback, you'll need to find a qualified biofeedback therapist. Contact the Biofeedback Certification Institute of America (BCIA) and ask for the names of people certified in your area. BCIA therapists must be licensed in another area of health care or be working under the guidance of a health care professional. You can also ask your doctor or another medical expert with knowledge of complementary and alternative medicine to recommend someone who has experience in treating the specific symptoms that are bothering you. As with any health care practitioner, you may have to meet with several individuals to find the one with whom you feel most comfortable.

For more information about biofeedback and other therapeutic approaches, please click on the linked websites listed below.

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