Biofeedback Practice, Theory, and Evidence

safety

Although biofeedback is generally considered safe, consult with a qualified healthcare professional before making decisions about new therapies and/or related health conditions.
Biofeedback may interfere with the use of some medications, such as insulin.
Behavioral modification therapies should not delay the time to diagnosis or treatment with more proven techniques or therapies, and should not be used as the sole approach to illnesses.

theory/evidence

Biofeedback is based on the concept that the mind can control the body. Using visual and auditory feedback from a variety of monitoring procedures and equipment, a biofeedback specialist aims to teach a person to control certain involuntary body responses such as brain activity, blood pressure, muscle tension, and heart rate. Once able to recognize and control these responses, individuals may be able to manage a wide range of mental and physical health problems.
There are hundreds of studies published using biofeedback for a variety of conditions including malnutrition, stress, complex regional pain syndrome, bladder disorders, heart problems, and hypertension.
Biofeedback may help reduce or even eliminate the need for medication in certain conditions, and possibly improve conditions that have not responded to other types of therapy. It is thought to help put a person in charge of his/her own healing by providing measurable feedback and monitoring progress and learning. Furthermore, using biofeedback may decrease medical costs.
Neurofeedback, using an EEG, has become a popular treatment for Attention Deficit Hyperactivity Disorder (ADHD), and electromyogram (muscle tension) biofeedback has been widely studied and accepted as a treatment for incontinence disorders (inability to control the urinary bladder or bowels). Small home biofeedback machines are becoming available for a variety of uses.
Based on several studies, biofeedback may be superior to laxatives in the treatment of constipation. It has also been reported that preoperative behavioral training may hasten the recovery of urine control and decrease the severity of incontinence following radical prostatectomy (surgical removal of the prostate).
A review of several studies found that biofeedback-based behavioral treatments reduce blood pressure (BP) to a modest degree. Effect sizes were quite variable. According to the authors, thermal feedback and electrodermal activity feedback may be superior to EMG or direct BP feedback, which tend to produce null effects.
Pelvic floor rehabilitation, a form of biofeedback, may be an appealing treatment for patients with fecal incontinence. A study assessed the outcome of pelvic floor rehabilitation in a large series of consecutive patients with fecal incontinence due to different causes. Pelvic floor rehabilitation led to a modest improvement in severity of fecal incontinence, squeeze pressure and maximal tolerated volume. In a few patients, a substantial improvement of the baseline Vaizey incontinence score was observed. Further studies are needed to identify patients who are most likely to benefit from pelvic floor rehabilitation.
The results of one study conclude that biofeedback is equally effective compared to alpha-antagonists in the treatment of recalcitrant voiding dysfunction.
Habit cough is a persistent 'barking' cough that does not have a determined medical cause. A study evaluated a biofeedback approach using skin temperature feedback with a family focus in the treatment of an 11 year-old girl diagnosed with habit cough. Treatment consisted of six one-hour sessions involving skin-temperature biofeedback to teach relaxation during coughing episodes. The girl was cough-free at the end of the sixth session and remained cough-free at the end of one and two year follow-up observations. It is noteworthy that the girl demonstrated a significant ability to increase skin temperature when asked to control her cough.
Despite promising studies for a variety of conditions, critics argue that there is no consistent evidence to suggest that autogenic training is superior to other interventions for prevention of tension headaches. Further studies should investigate the use of standard autogenic training in patients with moderate headache.

technique

Biofeedback training may be performed in physical therapy clinics, medical centers and hospitals. A typical biofeedback session lasts 30 to 60 minutes. The cost varies depending on whether a person's insurance covers all or part of the procedure. Different doctors or health institutions may charge varying amounts.
During a biofeedback session, a therapist applies electrical sensors to different parts of a patient's body. These sensors will monitor the physiological response to stress, for example, muscle contraction during a tension headache, and then feed the information back to a person via auditory (hearing) and visual (seeing) cues. These cues may be in the form of a beeping sound or a flashing light. With this feedback, a person may begin to associate the body's response with certain physical functions, such as muscles tensing.
The next step is to learn how to invoke positive physical changes in the body, such as relaxing specific muscles when the body is physically or mentally stressed. The goal of biofeedback is to eventually be able to produce these responses alone, outside of the therapist's office and without the help of technology.
Several techniques may be used to gather information about an individual's bodily responses. The one used may depend on individual health conditions and objectives, and is determined by a biofeedback practitioner. Machines and techniques may include:
Electroencephalogram (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 process is also known as neurofeedback.
Electromyogram (EMG): An EMG uses electrodes or other types of sensors to measure muscle tension. The EMG makes a patient aware of muscle tension allowing him/her to recognize the feeling early on and try to control the tension right away. EMG may be used to promote the relaxation of those muscles involved in backaches, headaches, neck pain and grinding 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.
Galvanic skin response training: Sensors measure the activity of a person's sweat glands and the amount of perspiration on the skin, indicating the presence of anxiety. This information can be useful in treating emotional disorders such as phobias, anxiety and stuttering.
Temperature biofeedback: Sensors attached to fingers or feet measure skin temperature. Because body temperature often drops when under stress, a low reading can prompt a person to begin relaxation techniques. Temperature biofeedback may help treat certain circulatory disorders, such as Raynaud's disease, or reduce the frequency of migraines.