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Table of Contents > Treatment Options > Biofeedback
Biofeedback

What is biofeedback?

Biofeedback is a technique in which people are trained to improve their health by learning to control certain internal bodily processes that normally occur involuntarily, such as heart rate blood pressure, muscle tension, and skin temperature. These activities can be measured with electrodes and displayed on a monitor that both the participant and his or her practitioner can see. The monitor provides feedback to the participant about the internal workings of his or her body. This person can then be taught to use this information to gain control over these "involuntary" activities. Biofeedback is an effective therapy for many conditions, but it is primarily used to treat high blood pressure, tension headache, migraine headache, chronic pain, and urinary incontinence.

Are there different types of biofeedback?

The three most commonly used forms of biofeedback therapy are:

  • Electromyography (EMG), which measures muscle tension
  • Thermal biofeedback, which measures skin temperature
  • Neurofeedback or electroencephalography (EEG), which measures brain wave activity

How does biofeedback work?

Scientists are not able to explain exactly how or why biofeedback works. However, there does seem to be at least one common thread: most people who benefit from biofeedback have conditions that are brought on or made worse by stress. For this reason, many scientists believe that relaxation is key to successful biofeedback therapy. When a body is repeatedly stressed, internal processes like blood pressure become overactive. Guided by a biofeedback therapist, a person can learn to lower his or her blood pressure through relaxation techniques and mental exercises. When a person successfully relaxes and lowers his or her blood pressure, the feedback signals reflect this accomplishment. This acts as affirmation and encouragement for the person's continued efforts.

What happens during a biofeedback session?

In a normal biofeedback session, electrodes are attached to the skin. These electrodes then feed information to a small monitoring box that translates the physiologic responses into a tone that varies in pitch, a visual meter that varies in brightness, or a computer screen that varies the lines moving across a grid. The biofeedback therapist then leads the person in mental exercises. Through trial and error, people can soon learn to identify and control the mental activities that will bring about the desired physical changes.

What is biofeedback good for?

Various forms of biofeedback appear to be effective for a range of health problems. For example, biofeedback shows considerable promise for the treatment of urinary incontinence, which affects over 15 million Americans. Many people prefer biofeedback over medicine because of the lack of side effects. One early study found that biofeedback improves bladder function and reduces symptoms of urinary incontinence by up to 94 percent. Based on these and other findings, the Agency for Health Care Policy and Research has recommended biofeedback therapy as a treatment for urinary incontinence. Biofeedback also appears to be helpful for people with fecal incontinence.

Research also suggests that thermal biofeedback may soothe the symptoms of Raynaud's disease (a condition that causes diminished blood flow to fingers, toes, nose or ears) while EMG biofeedback has been shown to reduce pain, morning stiffness, and the number of tender points in people with fibromyalgia. In addition, a review of scientific studies found that biofeedback may help people with insomnia fall asleep.

In addition, one preliminary study found that the combination of temperature biofeedback and EEG neurofeedback helped alcoholics feel less depressed and more likely to abstain from drinking alcohol.

Biofeedback can also be used effectively for certain ailments in children. For example, EEG neurofeedback (especially when combined with cognitive therapy) has been shown to improve behavior and intelligence scores in children with attention deficit/hyperactivity disorder (ADHD). Biofeedback combined with fiber may also help relieve abdominal pain in children. Thermal biofeedback helps well alleviate migraine and chronic tension headaches among children and adolescents as well.

Biofeedback may also be useful for the following health problems:

  • anorexia nervosa
  • anxiety
  • asthma
  • autism
  • back pain
  • bed wetting
  • chronic pain
  • constipation
  • depression
  • diabetes
  • fecal incontinence
  • epilepsy and related seizure disorders
  • head injuries
  • high blood pressure
  • learning disabilities
  • motion sickness
  • muscle spasms
  • sexual disorders, including pain with intercourse
  • spinal cord injuries

How many sessions will I need?

Each session generally lasts less than one hour. The number of sessions required depends on the condition being treated. Many people begin to see results within 8 to 10 sessions. Treatment of headache, incontinence, and Raynaud's disease (as mentioned a condition that causes diminished blood flow to the fingers, toes, nose, or ears) requires at least 10 weekly sessions and then less frequent sessions as health improves. Conditions like high blood pressure, however, usually require 20 weekly biofeedback sessions before improvement can be seen. In addition to these sessions, you will also be taught mental exercises and relaxation techniques that can be done at home and must be practiced at least 5 to 10 minutes every day.

Are there any risks associated with biofeedback?

Biofeedback is considered a safe procedure. No negative side effects have been reported.

How can I find a qualified practitioner?

Specialists who provide biofeedback training range from psychiatrists and psychologists to nurses, dentists, and physicians. The Association for Applied Psychology and Biofeedback (www.aapb.org) is the national membership association for professionals using biofeedback and is a good resource for finding qualified biofeedback practitioners in your area. To receive a directory of trained biofeedback specialists in your area, write to the AAPB at 10200 W. 44th Avenue, Suite 304, Wheat Ridge, CO 80033-2840 or call them at 800-477-8892.

Supporting Research

AHCPR. Clinical Practice Guideline Number 2: Urinary incontinence in adults: acute and chronic management. Rockville, MD: Agency for Health Care Policy and Research, US Dept of Health and Human Services; 1996. AHCPR publication 96-0682.

Annequin D, Tourniaire B, Massiou H. Migraine and headache in childhood and adolescence. Pediatr Clin North Am. 2000;47(3):617-631.

Bergeron S, Binik YM, Khalife S, et al. A randomized comparison of group cognitive-behavioral therapy, surface electromyographic boidfeedback, and vestibulectomy in the treatment of dyspareunia resulting from vulvar vestibulitis. Pain. 2001;91:297-306.

Berman BM, Complementary medicine treatments for fibromyalgia syndrome. Baillieres Best Pract Res Clin Rheumatol. 1999;13(3):487-492.

Burgio KL, Whitehead WE, Engel BT. Urinary incontinence in the elderly. Bladder-sphincter biofeedback and toileting skills training. Ann Intern Med. 1985;103(4):507-515.

Chesson AL, Anderson WM, Littner M, et al. Practice parameters for the nonpharmacological treatment of chronic insomnia. Sleep. 1999;22(8):1128-1133.

Dobie TG, May JG. Cognitive-behavioral management of motion sickness. Aviat Space Environ Med. 1994;65(10 Pt 2):C1-C20.

Douglas J. Constipation overview: evaluation and management. [Review] Curr Womens Health Rep. 2002;2(4):280-284.

Freedman RR. Physiological mechanisms of temperature biofeedback. Biofeedback Self Regul. 1991;16(2):95-115.

Glazier DB, Ankem MK, Ferlise V, Gazi M, Barone JG. Utility of biofeedback for the daytime syndrome of urinary frequency and urgency of childhood. Urology. 2001;57(4):791-793.

Gormley EA. Biofeedback and behavioral therapy for the management of female urinary incontinence. [Review] Urol Clin North Am. 2002;29(3):551-557.

Heyman S, Wexner SD, Vickers D, Nogueras JJ, Weiss EG, Pikarsky AJ. Prospective randomized trial comparing four biofeedback techniques for patients with constipation. Dis Colon Rectum. 1999;42:1388-1393.

Humphreys PA, Gevirtz RN. Treatment of recurrent abdominal pain: components analysis of four treatment protocols. J Pediatr Gastroenterol Nutr. 2000;31(1):47-51.

Integration of behavioral and relaxation approaches into the treatment of chronic pain and insomnia. NIH Technology Assessment Panel on Integration of Behavioral and Relaxation Approaches into the Treatment of Chronic Pain and Insomnia. JAMA. 1996;276(4):313-318.

Jones DR, Levy RA, Gardner L, Marsh RW, Patterson JC. Self-control of psychophysiologic response to motion stress: using biofeedback to treat airsickness. Aviat Space Environ Med. 1985; 56(12):1152-1157.

Jozsvai EE, Pigeau RA. The effect of autogenic training and biofeedback on motion sickness tolerance. Aviat Space Environ Med. 1996;67(10):963-968.

Labarthe D, Ayala C. Nondrug interventions in hypertension prevention and control. Cardiol Clin. 2002;20(2):249-263.

Lehrer P. Emotionally trigger asthma: a review of research literature and some hypotheses for self-regulation therapies. Appl Psychophysiol Biofeedback. 1998;23(1):13-41.

Lehrer P, Feldman J, Giardino N, Song HS, Schmaling K. Psychological aspects of asthma. J Consult Clin Psychol.

Leventhal LJ. Management of fibromyalgia. Ann Intern Med. 1999;131:850-858.

Loening-Bauchke V. Biofeedback training in children with functional constipation. A critical review. Dig Dis Sci. 1996;41:65-71.

Lubar JF, Swartwood MO, Swartwood JN, O'Donnell PH. Evaluation of the effectiveness of EEG neurofeedback training for ADHD in a clinical setting as measured by changes in T.O.V.A. scores, behavioral ratings, and WISC-R performance. Biofeedback Self Regul. 1995;20(1):83-99.

Mariani L. Vulvar vestibulitis syndrome: an overview of non-surgical treatment. Eur J Obstet Gynecol Reprod Biol. 2002;101(2):109-112.

Mauskop A. Alternative therapies in headache - is there a role? Med Clin N Am. 2001;85(4):1077-1084.

McGrady A , Horner J. Role of mood in outcome of biofeedback assisted relaxation therapy in insulin dependent diabetes mellitus. Appl Psychophysiol Biofeedback. 1999;4:79-88.

McGrady A, Graham G, Bailey B. Biofeedback-assisted relaxation in insulin-dependent 1

diabetes: a replication and extension study. Ann Behav Med. 1996;18:185-189.

McGrady A, Bailey BK, Good MP. Controlled study of biofeedback-assisted relaxation in type I diabetes. Diabetes Care. 1991;14:360-365.

Millea PJ, Brodie JJ.Tension-type headache. [Review] Am Fam Physician. 2002;66(5):797-804.

Norton C, Kamm MA. Anal sphincter biofeedback and pelvic floor exercises for faecal incontinence in adults--a systematic review. Aliment Pharmacol Ther. 2001;15(8):1147-1154.

Norton C, Kamm MA. Outcome of biofeedback for faecal incontinence. Br J Surg. 1999;86(9):1159-1163.

Pop-Jordanova N. Psychological characteristics and biofeedback mitigation in preadolescents with eating disorders. Ped Int. 2000;42:76-81.

Powers SW, Mitchell MJ, Byars KC, Bentti AL, LeCates SL, Hershey AD. A pilot study of one-session biofeedback training in pediatric headache. Neurology. 2001;56(1):133.

Rao SS. The technical aspects of biofeedback therapy for defecation disorders. Gastroenterologist. 1998;6(2):96-103.

Resnick NM. Improving treatment of urinary incontinence. JAMA. 1998;280(23):2034-2035.

Reynaud's Treatment Study Investigators. Comparison of sustained-release nifedipine and temperature biofeedback for treatment of primary Raynaud phenomenon. Results from a randomized clinical trial with 1-year follow-up. Arch Intern Med. 2000;160(8):1101-1108.

Rudolph W, Galandiuk S. A practical guide to the diagnosis and management of fecal incontinence. Mayo Clin Proc. 2002;77(3):271-275.

Rusy LM, Weisman SJ. Complementary therapies for acute pediatric pain management. [Review]. Pediatr Clin North Am. 2000;47(3):589-599.

Sabo MJ, Giorgi J. Biofeedback. In: Novey DW, ed. Clinician's Complete Reference to Complementary and Alternative Medicine. St. Louis, Mo: Mosby; 2000:32-40.

Saxby E, Peniston EG. Alpha-theta brainwave neurofeedback training: an effective treatment for male and female alcoholics with depressive symptoms. J Clin Psychol. 1995;51(5):685-693.

Silberstein SD, Rosenberg J. Multispecialty consensus on diagnosis and treatment of headache. Neurology. 2000;54(8):1553.

Solomon GD. Chronic tension-type headache: advice for the viselike-headache patient. Cleve Clin J Med. 2002;69(2):167-172.

Thompson DL, Smith DA. Continence nursing: a whole person approach. Holist Nurs Pract. 2002;16(2):14-31.

Thompson L, Thompson M. Neurofeedback combined with training in metacognitive strategies: effectiveness in students with ADD. Appl Psychophysiol Biofeedback. 1998;23(4):243-263.

Wiesel PH, Norton C, Roy AJ, Storrie JB, Bowers J, Kamm MA. Gut focused behavioural treatment (biofeedback) for constipation and faecal incontinence in multiple sclerosis. J Neurol Neurosurg Psychiatry. 2000;69(2):240-243.


Review Date: December 2002
Reviewed By: Jacqueline A. Hart, MD, Department of Internal Medicine, Newton-Wellesley Hospital, Boston, Ma and Senior Medical Editor A.D.A.M., Inc.; Terry Yochum, DC, Rocky Mountain Chiropractic Center, Arvada, CO..

Copyright © 2004 A.D.A.M., Inc

The publisher does not accept any responsibility for the accuracy of the information or the consequences arising from the application, use, or misuse of any of the information contained herein, including any injury and/or damage to any person or property as a matter of product liability, negligence, or otherwise. No warranty, expressed or implied, is made in regard to the contents of this material. No claims or endorsements are made for any drugs or compounds currently marketed or in investigative use. This material is not intended as a guide to self-medication. The reader is advised to discuss the information provided here with a doctor, pharmacist, nurse, or other authorized healthcare practitioner and to check product information (including package inserts) regarding dosage, precautions, warnings, interactions, and contraindications before administering any drug, herb, or supplement discussed herein.

 
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