Biofeedback Mastery

Biofeedback Mastery

Have you ever wondered what Biofeedback is all about? Uncover these unique information on Biofeedback! Are you in constant pain? Do you wish you could ever just find some relief? If so, you are not alone. Relieving chronic pain can be difficult and frustrating.

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Historical Survey of Biofeedback Development

Psychophysiology is the scientific study of the interrelationships between cognitive, emotional, behavioral, and physiological processes. Biofeedback techniques and applications grew out of the research in psycho-physiology. Biofeedback research became widespread in the 1960s, when studies reported that a variety of presumable nonvoluntary responses could be brought under operant control. Many studies using electroen-cephalographic feedback were reported which indicated that alpha brain activity could be brought under voluntary control. As these studies gained the attention of clinicians, soon biofeedback was applied to treating various disorders such as migraine headache and hypertension. The growing body of research on stress also provided support for the use of biofeedback as a research tool as well as a treatment approach. Research on the effects of relaxation, meditation, and hypnosis in producing the relaxation response to counteract the effects of stress provided further...

Is biofeedback useful in MS

In recent years, biofeedback has become commonly used in the management of pain in pain clinics. The use of biofeedback now appears to be generally well accepted. However, in past studies with Dr. Ronald Melzack at McGill University, surprisingly, we found that Workman's Compensation patients with back pain responded better to biofeedback than MS patients with back pain did. Biofeedback, however, may be helpful in some MS patients. More sophisticated approaches to biofeedback have recently evolved from spinal cord injury centers and other medical clinics.

Research Investigations on How Biofeedback Works

In the late 1970s and early 1980s research in biofeedback was focused on evaluating the different models of biofeedback discussed above. Many interesting findings were reported, but more questions were raised than were answered as to how biofeedback works. Much of the recent research on biofeedback has focused on evaluating the clinical efficacy of biofeedback, and little systematic work is now being done on discovering how it works. In order to address the question of how it works some researchers have attempted to design false feedback studies. Results of these studies have been mixed, with some studies reporting that even when false feedback is given subjects alter their response as instructed. Some researchers have compared biofeedback training with relaxation only and found that in both conditions, decreases in ANS arousal can be achieved. Other researchers are now examining the role of cognitions in the biofeedback process. The bottom line is that we are not sure how it works...

Future Directions in Research Clinical Practice and Biofeedback Technology

Biofeedback is alive and well as there continues to be a steady output of high-quality research, greater acceptance of biofeedback as a clinical tool, and improvements in technology. Although biofeedback has been used to treat problems, it may have advantages in helping individuals develop self-regulation skills to prevent mental and physical health problems. For example, a study was reported in which children with no clinical problems were taught skin-temperature bio- feedback. These children learned to relax and incorporated this in their daily schedule. They also demonstrated decreases in anxiety and depression scores, even though these scores were in the normal range. Biofeedback may have helped them achieve a greater degree of psychological health. With the advent of greater access to personal computers people may be able to purchase inexpensive biofeedback devices that they can use at home to teach themselves self-regulation skills. Of course, as with all self-help approaches,...

Establishing a Biofeedback Laboratory

A minimum requirement would be to establish a large enough area that could hold a recliner, a chair for the individual conducting the biofeedback session, the Biofeedback biofeedback equipment, a personal computer, and lighting that can be dimmed. After space is established for the laboratory then the practitioner would begin searching for the type of equipment that would serve the goals of the practitioner. There are several nationwide companies that can be contacted to provide bids on biofeedback equipment. Some individuals prefer to buy individual biofeedback components for each response, often called stand alone'' modules. Another approach would be to purchase the preamplifier amplifier components that various transducers and electrodes could be plugged into. In order to connect the biofeedback equipment to a computer a component called an analog-to-digital converter needs to be purchased.

Electroencephalographs Biofeedback

Electroencephalographic (EEG) biofeedback is another frequently used biofeedback training method with children and adults. EEG biofeedback gives information about the brain's electrical activity. Brain waves have been classified into four states beta, which occurs when the individual is wide awake and thinking alpha, which is associated with a state of calm relaxation theta, which reflects a deep reverie or light sleep and delta, which is associated with deep sleep. In the typical procedure the subject is provided with feedback about the presence or absence of some specified amplitude and or frequency of brain electrical activity. Often the goal of EEG biofeedback is to produce alpha waves because they are associated with relaxation.

Biofeedback Relaxation Training and Stress Management

The question has been raised as to the difference in effectiveness of outcome between biofeedback and relaxation training in reducing stress. This has been a controversial question as many clinicians and researchers argue that you can get the same benefits from relaxation strategies as from biofeedback for most problems. Furthermore, they point out that the relaxation strategies are not as costly nor do they require knowledge of complicated equipment. Only a few large-scale controlled outcome studies on the efficacy of biofeedback as compared to other behavioral techniques in the management of physiological disorders have been reported. Most of these do not find that biofeedback provides a distinct advantage over other behavioral procedures. The selectivity of physiological control often achieved by biofeedback methods would suggest that the methods would have a unique advantage in disorders in which the symptom is quite specific, for example, cardiac arrhythmias, seizure disorders,...

Research on Differences between Childrens and Adults Responses to Biofeedback

In general children are more open and responsive to biofeedback than adults. Children are usually fascinated with the equipment, and motivation and curiosity are high. Research on nonclinical populations response to biofeedback indicate that children between the ages of 8 and 12 are able to achieve greater changes in physiological responses using biofeedback than any other age group. For clinical groups biofeedback may be a good alternative to medication if the medical treatment has potentially negative short- and long-term consequences for the developing child. Research evaluating the effectiveness of biofeedback with children who have headaches indicates that more children improve and to a greater degree than do adults. Besides play therapy, behavior modification, and some of the newly developed cognitive strategies, there are only a few individual therapy techniques to be used directly with children. Most interventions involve changing or teaching parenting skills, or manipulating...

Research on the Best Methods of Biofeedback

Biofeedback Studies indicate that changes in symptoms come slowly with most changes occurring four to six weeks after biofeedback therapy has begun. It is important to explain to the patient that biofeedback does not work like most medication and that changes occur slowly and often accompany a real change in the person's behavior and attitude about the problem and how to cope with it. Also, biofeedback may not eliminate the symptoms but it may reduce the intensity, frequency, and or medication usage.

Electromyographic Biofeedback

Electromyographic (EMG) biofeedback is the most widely used biofeedback technique with both children and adults. EMG biofeedback provides information about the individual's striate muscle tension in the area where the electrodes are attached. As the muscle constricts it generates an electrical current between one motor neuron and the next. The EMG sensors pick up the intensity of that electrical current. Typically, there is one reference electrode that is used and two active electrodes. It is important to place the electrodes lengthwise over the muscle of interest so that the electrodes are picking up the electrical current as it moves from one motor neuron to the next within the same muscle. If the electrodes are placed on two different muscles, then the information obtained reflects the electrical difference between two different muscles. The muscles most commonly monitored are the frontalis, masseter and trapezius muscles. The frontalis is the forehead muscle that tenses when an...

Heart Rate Blood Pressure Pulse and Volume Biofeedback

The heart rate monitor uses electrodes to measure the action of the heart muscle. Heart rate biofeedback usually involves measuring heart beats per minute. In general, greater SNS arousal is associated with a faster heart rate, and a relaxed state is associated with decreased heart rate. Blood pressure biofeedback monitors the diastolic and the systolic pressure of the cardiovascular system. Increases in blood pressure reflect greater SNS arousal thus, in most cases the goal of blood pressure biofeedback is to reduce the pressure.

Galvanic Skin Response Biofeedback

A feedback dermograph measures the electrical conductance or electrical potential in the individual's skin. The galvanic skin response (GSR) biofeedback machine can monitor minute changes in the concentration of salt and water in sweat gland ducts. The natural metabolism of cells produces a slight voltage Biofeedback The GSR has been used in lie detectors as a measure of emotional arousal. The sympathetic branch of the autonomic nervous system controls sweating. GSR biofeedback helps the individual gain control of the arousal produced by the autonomic nervous system. Two sensors or electrodes are usually placed on the ends of two fingers. Many clinicians prefer not to use GSR responses because they change rapidly and often respond to irrelevant stimuli.

Definition of Biofeedback

Biofeedback is any process in which an external device generates information to an individual about his or her physiological responses and that allows the individual to then regulate these responses and receive feedback on changes in the physiological responses. The physiological responses may be any responses that can be measured by an external device. The most common responses measured are muscle tension, heart rate, skin-temperature, and galvanic skin response. The feedback may be in a variety of forms, the most Biofeedback Biofeedback can also be considered a methodology used in studying psychophysiological processes. The methodology includes a baseline measurement of the physiological response(s), then feedback is given to an individual with some sort of instruction to manipulate the physiological response(s). The physiological response is measured during feedback and compared to the baseline measurement. Inferences are then drawn as to the relationship between the physiological...

How and Why Biofeedback Is Used in Clinical Settings

A major use of biofeedback is to teach relaxation skills. A second use of biofeedback is to alter pathophysiological processes such as blood flow or SNS arousal for migraine headache patients, to decrease the flow of gastric juices for ulcer patients, to decrease muscle tension and increase proper posture for the chronic back-pain patient. Biofeedback should be considered as a therapeutic tool that can help introduce the client to therapy in a concrete and nonthreaten-ing manner. It can be especially useful for the patient who focuses on physical problems or insists his problems are not physiological. Biofeedback can also be used to increase feelings of self-efficacy and self-control. The client learns quickly the connection between emotions, thoughts, and physiological responses. Biofeedback may be used when there are no viable medical alternatives, or when the physician determines that medication should not be used. Sometimes patients do not want to take medication and biofeedback...

Components of the Biofeedback Laboratory

The biofeedback laboratory should be a quiet room free from visual distractions. A recliner chair allows the subject to rest comfortably. The laboratory equipment can vary depending on the goals of the clinician and purposes for which the biofeedback will be used. With the advances in technology, most biofeedback systems are quite compact and attractive. Some of these systems are integrated with a computer screen and will allow for printing of and or computer display of the feedback. A computer system is advisable so that the results of the biofeedback session can be stored for future reference. Biofeedback instruments monitor physiological responses of interest and allow for measurement of these responses. The instrumentation then presents it in a way that the individual can use and manipulate the information.

Clinical Issues in Using Biofeedback

Biofeedback can be abused if it used outside of the context of therapy. It cannot be used in the same manner that one would administer medication. Individual differences must be noted and addressed using an individualized protocol before biofeedback can be suc Biofeedback cessful. Also, the individual should be closely monitored and changes recommended if problems arise. Biofeedback may be successful in the clinic, but patients may not be able to modify their responses in the natural environment without biofeedback. Thus the development of self-control should be included in the protocol. Sometimes a person's baseline physiological responses are normal, but the individual may experience exaggeration of SNS responses when stressed. Biofeedback should be focused on helping these individuals decrease SNS arousal during stressful situations. Thus, in biofeedback therapy it is important to teach biofeedback skills in a variety of situations and intensities of stimuli. Biofeedback allows for...

Biofeedback

Biofeedback is a technique in which an instrument produces auditory or visual signals in response to changes in a subject's blood pressure, heart rate, muscle tone, skin temperature, brain waves, or other physiological variables. It gives the subject awareness of changes that he or she would not ordinarily notice. Some people can be trained to control these variables in order to produce a certain tone or color of light from the apparatus. Eventually they can control them without the aid of the monitor. Biofeedback is not a quick, easy, infallible, or inexpensive cure for all ills, but it has been used successfully to treat hypertension, stress, and migraine headaches.

Theory of Voluntary Control

The theory of voluntary control proposed by Brener emphasizes discrimination and awareness of internal bodily responses and processes. Biofeedback is thought to aid the individual in the learning process and increase awareness of sensations related to physiological responses, or to sensitize the individual to other motor responses as a means of mediating voluntary control over the physiological changes. Thus, emphasis is given to learned physiological control as a form of complex human learning of motor skills.

Psychobiological Model

All three of the theories discussed thus far have been supported by some empirical data. There are a number of studies that attempt to isolate and differentiate the effects of the hypothesized variables. At this stage of knowledge, there is no strong empirical evidence to support one viewpoint over another. The psycho-biological model integrates these concepts by emphasizing the interrelationships between psychological processes and biological processes. The psychobio-logical model supports the view that biofeedback helps the self-regulation of the individual's total functioning. The concepts from the information modeling approach provide a way to explain how needed feedback is provided that will allow for better self-regulation. The concepts from the operant approach

Professional and Research Opportunities

Reports on studies of biofeedback have steadily declined over the past 10 years. This is unfortunate as there are still so many unanswered questions regarding how and why biofeedback works. The area of biofeedback research provides a wealth of opportunities, particularly as technology improves and instrumenta Biofeedback tion becomes more reliable and valid. There are now more training opportunities to learn biofeedback instrumentation and methodology. The Biofeedback Society of America encourages continued scientific investigations of biofeedback, and there are numerous high-quality scientific journals that publish biofeedback research, including Psychophysiology Biofeedback and Self-Regulation and Biofeedback and Behavioral Medicine. On the professional level biofeedback techniques and therapy have become more widely accepted as a method of treatment for numerous mental and physical problems. Those interested in developing a profession in biofeedback can contact the two national...

Supplemental Reading

Binnie NR, Papachrysostomou M, Clare N, Smith AN. Solitary rectal ulcer the place of biofeedback and surgery in the treatment of the syndrome. World J Surg 1992 16 836-40. Vaizey CJ, Roy AJ, Kamm MA. Prospective evaluation of the treatment of solitary rectal ulcer syndrome with biofeedback. Gut 1997 41 817-20.

Results of the EMG Study

On the other hand, tonic activity was observed less often in patients with high anomalies. These results suggest that patients with high anomalies have a congenital functional problem of the external sphincter muscle. Molander and Frenckner 5 showed that the presence of an inflation reflex correlated well with the development of voluntary anal continence. In our study the inflation reflex was much more common in normal subjects and in patients with low anomalies. From the point of view of the inflation reflex, the function of the external sphincter is more frequently disturbed in patients with high anomalies. Electrical activity during further rectal filling is an index of external sphincter function in patients with high anomalies, as is tonic activity or the inflation reflex. The results of phasic activity indicate that although patients with high anomalies may have congenitally rudimentary external sphincter muscles, they may still be able to improve their...

Postoperative Electromanometric Myographie and Anal Endosonographie Evaluations

We have two main objective assessments physiological examinations and imaging studies. In this chapter we describe our experience with postoperative electromanometric, electromyographic, and anal endosonographic evaluations, in addition to the use of biofeedback therapy.

Psychological Interventions

Patients with the IBS who actively seek care by a physician have a high incidence of psychological disorders, specifically depression and anxiety. Because of this, a variety of psychological interventions have been used to treat the symptoms of IBS. Despite methodological flaws in most studies, there are some data to support the use of relaxation exercises, biofeedback, cognitive therapy, hypnotherapy, and psychotherapy (Talley et al, 1996). The IBS-related symptoms most likely to respond to psychological intervention include abdominal

Defective Sphincteric Continence

Physical examination of the sphincter in these patients reveals low resting tone and sometimes low squeeze pressures, findings that can be confirmed by anal manometry if necessary. Effective management involves the judicial use of antidiarrheals such as loperamide, 2 to 4 mg 30 minutes before meals, and fiber supplements to increase stool consistency. Biofeedback may be helpful later, for those patients whose sphincter function returns only slowly or incompletely retraining of patients to use the external anal sphincter to greater advantage can be helpful. In a minority of IPAA patients, incontinence due to poor sphincter tone persists, and is occasionally sufficient to require permanent ileostomy. This is one of the reasons for pouch failure.

Management of Unexplained Chest Pain

Nonpharmacologic approaches can be useful in unexplained chest pain, just as in other functional gastrointestinal disorders. Cognitive behavioral psychotherapy, deep muscle relaxation, biofeedback, and other stress reduction techniques, are beneficial for some patients. Transcutaneous electrical nerve stimulation, acupuncture, and other alternative approaches, have had anecdotal success, but the best advice is to learn to maximize the use of antidepressants, particularly TCAs, in this patient group.

Behavioral and Psychological Approaches

Although pharmacologic therapy has a valuable role in these patients, it is also clear that a successful outcome requires taking into consideration several, equally important, factors. As explained previously, chronic pain cannot be viewed as a purely neurophysiologic phenomenon and has many other facets, the most important of which is the psychological dimension, consisting of cognitive, emotional and behavioral processes. The combination of these factors results in functional disability, a third dimension of chronic pain that is often ignored. Several psychological techniques have been used with good effect in the management of a variety of chronic pain syndromes, although specific evidence for their efficacy in chronic abdominal pain syndromes is generally lacking. Operant interventions focus on altering maladaptive pain behaviors, such as reduced activity levels, verbal pain behaviors and excessive use of medications. Cognitive behavioral therapy extends beyond this to also...

Sources Of Information

Sources of data include interviews, responses to written or pictorial measures, data gathered by clients and significant others (self-monitoring), observation in the interview as well as in role play or in real-life settings, and physiological indicators. A variety of electromechanical aids are available for collecting data such as wrist counters, timers, biofeedback devices, and audio- and videotape recorders. Familiarity with and knowledge about different methods, as well as personal and theoretical preferences and questions of feasibility influence selection. Preferred practice theories strongly influence selection of assessment methods. For example, in individually focused psychodynamic approaches, self-report and transference effects within the interview may be the main source of data used.

Therapeutic Alternatives and Developping Treatments in Refractory Urge Incontinence and Idiopathic Bladder Overactivity

Conservative therapies such as pelvic floor exercises, bladder retraining, electrical stimulation of the pelvic floor and pharmacotherapy involving anticholinergics, antispasmodics and tricyclic antidepressants are primary discussed. The use of pelvic floor muscle training with or without biofeedback for overactive bladder is suggested to inhibit detrusor muscle contraction by voluntary contraction of the pelvic floor at the same time, and to prevent sudden falls in urethral pressure by change in pelvic floor muscle morphology, position and neuromuscular function 17 . Some promising results have been reported, and these treatments are widely used, but there is still a need for high quality randomized trials on the effect of pelvic floor exercises on the inhibition of detrusor contraction. Detrusor over-activity current pharmacological treatment involve use of muscarinic receptor antagonists, but their therapeutic activity is limited by side effects resulting in the non continuance of...

Venous Sinus Obstruction in Pseudotumor Cerebri Syndrome Cause or Effect

Dural Sinus Stenosis Stent

The effects of relieving the venous sinus obstruction in PTS have also been studied. The results of these studies will be considered fully in the section on treatment (vide infra). However, it is clear that reduction of venous sinus hypertension in PTS may result in rapid clinical resolution and a reduction in CSF pressure. Of the cases reported to date, significant clinical improvement was apparent in 4 of 4 cases in our series 130 and in 8 of 12 cases in the series from Cambridge 63 . These results, along with the observation that some obstructions are intrinsic, indicate that venous sinus obstruction in PTS may have a primary aetiological role, possibly exacerbated by raised ICP due to disordered positive biofeedback. We therefore propose the following unifying hypothesis. Normally, increased CSF pressure leads to increased CSF drainage and restoration of normal CSF pressure, representing classical physiological biofeedback control where the response of the system has a negative...

Outlet Dysfunction Constipation

Of the striated muscles during attempted defecation (pelvic floor dyssynergia), weak expulsion forces due to pain or neuromuscular disorders, or misdirection of expulsion forces secondary to a large rectocele. We recommend biofeedback in conjunction with conservative therapy if pelvic floor dyssynergia is demonstrated with appropriate testing (Figure 75-1). The purpose is to train patients to relax their pelvic floor muscles during straining to achieve defecation. Biofeedback sessions are held weekly or more often until abnormal defecation efforts are achieved (approximately three to eight sessions). The rate of success for biofeedback has been reported to be 60 to 90 by some, but not all, investigators, but there have been no randomized controlled studies in adults and the experience in children has been disappointing in large controlled studies. In our experience, less than 50 of patients with constipation associated with pelvic floor dyssynergia respond to biofeedback. The cost of...

Information Processing Model

In defining biofeedback training, the concept that the individual is fed back information about biologi- Biofeedback cal responses that he or she is not aware of is important. This information provides a sensory analog of the currently occurring physiological responses. Information is provided to the individual at the same instant that the physiological activity is occurring or after a very brief delay. Therefore, some part of the output of a process is now introduced into the input of a process so as to alter the information processing. According to the information processing model, biofeedback stimuli can be conceived of as a symbolic representation of the physiological event, and the individual engages in a response to either reduce or enhance the biofeedback stimuli, resulting in changes in the physiological responses themselves. Research in this area may evaluate different types of feedback stimuli to determine the best display of information. This may include examining the...

Alternative Complementary And Integrative Medicine

Uncontrolled medical diversity, and quackery. Nevertheless, hospitals, academic medical centers, and medical schools are attempting to attract new patients and consumers by offering programs for wellness, stress reduction, yoga, meditation, massage, biofeedback, Shirodhara (warm herbalized sesame oil dripped onto the forehead), acupressure, aromatherapy, and so forth. The American Hospital Association found that more than 15 percent of all hospitals were offering alternative therapies, including walk-in complementary medicine centers.

Medical Management

Biofeedback Biofeedback therapy confers the distinct advantage of a noninvasive intervention that is safe, that allows (requires) active patient participation, and that may enhance the effects of other treatments (Jensen and Lowry, 1997). Patients perform anal sphincter contraction exercises and receive computerized visual or auditory responses thus, they learn muscle control by means of sensory feedback. Anorectal biofeedback therapy specifically aims (1) to augment external anal sphincter function, resulting in successful voluntary delay of defecation, (2) to improve rectal sensation, thereby alerting patients to the presence of stool in the vault and the need for voluntary sphincter contraction, and (3) to coordinate sensation and contraction, thereby overcoming reflexive relaxation in the presence of rectal contents (Loening-Baucke, 1990). A trained, dedicated, and sensitive therapist is essential in biofeedback therapy. To qualify for biofeedback therapy, patients must be capable...

Anal Endosonography

Fig. 26.5 Voluntary contraction pressures and phasic activities of the external sphincter before (A) and after (B) biofeedback therapy. Voluntary contraction pressures and electrical activities of the phasic activities are increased after therapy Fig. 26.5 Voluntary contraction pressures and phasic activities of the external sphincter before (A) and after (B) biofeedback therapy. Voluntary contraction pressures and electrical activities of the phasic activities are increased after therapy

The MACE Procedure

Bowel management is necessary in the majority of ARM in the postoperative period. Fecal incontinence in some patients and intractable constipation in others are the main problems. Initially, conservative measures including aggressive potty training, dietary management, different medications, daily retrograde enemas, and biofeedback therapy in suitable patients are used to overcome these complications. Pe a has reported a detailed bowel management program for ARM patients 59 . Reoperations for some patients can involve reconstructive surgical procedures such as gracilisplasty or, rarely, permanent stoma. Conservative measures should be initially undertaken in all patients. Patients that have success with daily retrograde enemas are good candidates for the MACE procedure. The most common cause of failure in the long term in patients who have success with daily enemas is the dislike they develop for enemas administered through the anus as they grow older. Many patients, especially...