Biofeedback is a technique that teaches people how to control involuntary bodily functions like breathing, muscle tension, and heart rate through the use of electronic or electromechanical devices that provide feedback on these physiological processes. It involves learning to control external signals and eventually internal cues to gain awareness and control over one's body. Biofeedback sessions with a trained professional typically involve sensors attached to the body to monitor functions and provide audio or visual feedback to help the individual learn control through relaxation techniques and practice. While not a cure, biofeedback has been shown to help treat various conditions involving muscle tension and stress and is gaining wider acceptance in mainstream healthcare.

1. BIOFEEDBACK DEFINITION
Overview
Biofeedbackisatherapeutictechniquethatteachesyouhow tocontrol physical responsessuchas
breathing,muscle tension,handtemperature,heartrate,bloodpressure andbrainactivitythatare not
normallycontrolledvoluntarily.Thiscontrol isachievedbylearninghow tofocusonand modifysignals
fromyour body.Biofeedbackmaybe usedtohelppeople change the waytheirbodiesrespondtoa
varietyof conditions,includingchronicpain,stressandanxiety,toname a few.
The skill typicallyistaughtbya healthcare professionalwithexpertise inthe techniquesandusesa
handful of clinical,noninvasiveinstruments.Once youunderstandhow the technique isapplied,and
aftersome practice,itis usuallypossible touse the skill independently.
To understandbiofeedback,thinkof athermometer—anexternal devicethatmeasuresaphysiological
change.Biofeedbackuseselectronicorelectromechanical instrumentstomonitor,measure,process
and feedbackinformationaboutbloodpressure,muscle tension, heartrate,brainwavesandother
physiological functions.
Audioand/orvisual feedbacksignals,oftenprovidedthroughacomputer,reflectthisactivity.Thisgives
yougreaterawarenessandvoluntarycontrol:Firstyoulearnto control the external signal and,
eventually,youlearntorecognize anduse internal cues.
Biofeedbackisarelativelyrecentapproach,developedinthe 1940s. The termcame intouse around
1969 to describe proceduresthattrainedresearchsubjectstoalterbrainactivity,bloodpressure,
muscle tension,heartrate andother“involuntary”bodilyfunctions.The goal istotrainyou,primarilyby
changingthoughtprocesses,tocontrol physiologicresponses.
At first,biofeedbackwasviewedwithskepticism, butithasbeenincreasinglyacceptedbymainstream
healthcare professionalsandinsurers.Inthe last40 years,scientistshave beenexploringthe mind/body
connection.More acceptance andwidespreaduse of biofeedbacktherapyhasresulted.
Studiesindicate thatitisan effective therapy.Itisusedto helptreata range of illnessesandailments,
fromchronic painto constipationtoincontinence.Itisusuallyusedinadditiontoaprimarytreatmentto
emphasize self-controlorself-regulation.
Biofeedbackismosthelpful forconditionsinvolvingmuscle tension.It’saparticularlyuseful therapyfor
reducingstressandanxiety,andthe National Institutesof Healthhasapproveditsuse inthe treatment
of chronicpainand insomnia.Biofeedbackcanbe usedasboth a primaryand secondarytreatment.
Secondarytreatmentsare usedinconjunctionwithtraditional medicine.Forexample,biofeedback
wouldbe usedtodeal withthe trauma or fearof havinga disease likecancer;the painassociatedwith
the condition;andthe nauseafromchemotherapy.Biofeedbackisalsoasecondarytreatmentfor
diseaseslikemultiple sclerosis,Crohn’sdisease andotherconditionsthatare notconsideredcurable by
biofeedback,althoughsomesymptomsof theseconditionscanbe alleviatedwiththistherapy.

2. There are at least 150 applications for biofeedback,andthe listcontinuesto grow. Beloware some of
those uses:
 addictiontoalcohol,tobaccoand otherdrugs
 anxietydisorders
 asthma
 bruxism(teethgrinding)
 cardiac arrhythmia(abnormalitiesinheartbeat)
 chronicfatigue syndrome
 chronicpain
 circulatoryproblems(suchasRaynaud’sphenomenon)
 complex regional painsyndrome
 concentrationimprovementforeducationandmeditation
 control of brainwavesforspiritual developmentandinnertranquility
 constipation
 diabetes
 epilepsy
 fecal incontinence
 fibromyalgia
 headaches(includingmigraines)
 highbloodpressure
 insomnia
 irritable bowel syndrome andotherdigestive disorders
 jawpainand dysfunction(includingtemporomandibularjointsyndrome)
 menopausal symptoms
 menstrual cramps
 migraine headaches
 milddepression
 nauseaand motionsickness
 neuromuscularre-education
 paralysis,spinal cordinjuryandothermovementdisorders
 premenstrual syndrome
 stress
 torticollis(neckmusclescontractinvoluntarily,causingthe headtoturn)
 Tourette’ssyndrome
 urinaryincontinence
 vulvovaginalpain
Althoughbiofeedbackisperhapsmostcloselyassociatedwithstressrelief,new applicationsare being
developedregularly.Motionsicknessisone of the newestapplications. NASA usedbiofeedbacktohelp

3. astronautsdeal withspace sickness,andnow the space agency’stechniquesare beingusedtohelp
otherswhosufferfromnausea,vomitingandmotionsickness.
A particulartype of biofeedback,calledelectroencephalographic(EEG) biofeedback,orneurofeedback,
isusedfor a varietyof conditions.Throughneurofeedback,youlearntopayattentiontobrainwave
activityandultimatelycontrol it.Itmaybe helpful inreducinghyperactivityandattentiondeficit
hyperactivitydisorder,thoughstudiesare continuingtodetermine itseffectiveness.
Unlike manyotherapproachestohealthcare,biofeedbackputsyouincharge.Itrequiresyoutolearn
fromthe signalsyourbodysendsandmake changesaccordingly.Iteveninvolvespractice athome.And
afteryou finishyourbiofeedbacksessions,youneedtouse whatyoulearnedregularly.Youwill use it,of
course,to affectthe condition.Dailypractice,evenwhenyoursymptomsare respondingtotreatment,
reinforcesyourskills.
Dependingonthe conditionyou’retryingtochange,yourpractice periodmayrange from a couple of
minutesintermittentlyduringthe daytohalf-hoursessions.Youmightfocusona particularmuscle
group,a hand-warmingtechnique orsome othertechniquespecifictoyourneeds.
Biofeedbackand Hypnosis
Many healthprofessionalsuse bothhypnosisandbiofeedback,oftentogether.Infact,itis impossible to
teachbiofeedbackwithoutalsoteachingatype of self-hypnosisexercise,suchasimageryrelaxation,
progressive relaxationorimagerychange.
One benefitfromusingthe combinationof hypnotherapyandbiofeedbackisthatthe participant
recognizesquicklythatchangingthinkingchangesphysiologicresponses.Thisencouragesmental
practice towardthe goal of makinga desiredphysiologicchange permanent.
Diagnosis
Althoughbiofeedbackisharmless,yourhealthcare professional will wanttodoa thoroughexam
relatedtoyour condition.Thisgivesabetterunderstandingof the causesof yourmedical conditionand
guidesthe biofeedbacktherapistindevelopinganappropriate treatmentplan.Inaddition,the
physiological testingthatisdone before beginningtreatmentcanhelpyoumeasure yourprogressas
youproceedwithtreatment.
Biofeedbackisgenerallynota substitute forconventional medical treatment.Rather,itshouldbe used
withanyother therapiesprescribedbyyourhealthcare professional.
Overall,biofeedbackissafe:Itisnoninvasive andgenerallyhasnoside effects.However,if youare
deeply apprehensive,be sure todiscussyourconcernswiththe therapist.A healthydose of skepticism
and interestinthe detailsof yourcare shouldbe welcome.If atherapistdoesn’tansweryourquestions,
seekanothertherapist.Ultimately,youdon’thave to believe inbiofeedbackforitto work.But youwill
have to practice the techniquestodiscoverwhetherornottheyare effective foryou.Biofeedback
requiresthatyoube a responsiveparticipantinthe process.

4. Whetherbiofeedbackworksforyoudependsonyourparticularconditionandyourabilitytolearnfrom
the feedbackyoureceive.The amountof time youcommittohelpingyourbodyandmindmake the
necessarychangesiscrucial.Once a commitmentisthere,change will take place,butthe extentwill
dependonthe severityof yourcomplaintandthe abilityof yourbodytomake the necessarychanges.
Gettingstarted
To get started,you’ll needatrainedprofessional whocanoperate the monitoringequipmentand
interpretthe results.Biofeedbackprofessionalscome fromanumberof health-relateddisciplines,
includingpsychology,psychiatry,social work,medicine,dentistryandnursing.
Your healthcare professional maybe able tomake a referral.Physicians,dentists,psychologistsand
othersuse biofeedback.The psychologyorpsychiatrydepartmentata nearbyuniversityalsomaybe
able to pointyouinthe right direction.Andcheckwithyourhealthcare plan—itmaycoveryourvisitsto
approvedbiofeedbacktherapists.
Althoughthe practice isn’tlicensed,biofeedbacktherapistscanreceive certificationfromthe
BiofeedbackCertificationInstitute of America(BCIA).Tobe certified,theymustmeetcertaineducation
requirements,passanexamandeitherbe licensedinahealthcare fieldorwork underthe supervision
of a licensedhealthcare professional.The organizationoffersreferrals(www.bcia.org).BCIA estimates
that about1,500 healthcare professionalsin25 countriesare certifiedeitheringeneralbiofeedback,
EEG biofeedbackorpelvicmuscle dysfunction.
Treatment
Biofeedbacktypicallyinvolvesaseriesof sessionsoverseveral weeks.The lengthandnumberof
sessionsyouneedwill dependonyourconditionandhow fastyoucan learnto control yourphysical
responses.Some conditionsrequireas few asthree or foursessions,especiallyforchildren,whileothers
may require 10 timesthatmany or more.
Electroencephalographic(EEG) biofeedback—whichmeasures,displaysandteachesyoutocontrol
brainwaves—cantake longer.Some conditionsmayrequire 40or 50 EEG sessionsinthe clinic.Youand
your biofeedbacktherapistwill come upwithaschedule that’srightforyourcondition.
You can expecta sessiontolastfrom30 minutestoan hour.(Your firstone maytake longerasthe
therapistexplains the processtoyou.)
The biofeedbacktherapistwill firstexplainthe processtoyouandshow you the variouspiecesof
equipment.You’ll sitinacomfortable chair,andthe therapistwill applysensorstovariouspointson
your body(mosttypically,the shoulders,fingers,backand/orhead) dependingonyourcomplaintand
the protocol developedtobringaboutbeneficial change.Thismayvaryamongclinics.Forinstance,if
youhave headachesor insomnia,the sensorswill probablybe placedonyourscalp.
The sensorsare connectedtoequipmentthatprovidesinstantaneousfeedbackonthe functionyouare
tryingto control.What’sthisfeedbacklike?Itvaries.Some machinesshow youthe changesona

5. computermonitor.Othersbeeporbuzzor blinkorotherwise indicate fluctuationsinthe functionyou
are targeting.
Before the trainingbegins,the biofeedbackprofessional will take abaseline readingtofindwhatyour
“normal”state is; thismakesitpossible togauge changes.
Next,the therapistwillguide you throughvariousmental orphysical exercisesthatare designedtobring
aboutthe desiredbiological changes—exercisesthatcanhelpyoucontrol a particularfunction.Andby
payingattentiontothe feedback,you’ll learntoassociate certainthoughtsand actionswiththe desired
change in yourpreviouslyinvoluntaryresponses.Sensorsare attachedtoyour bodyto monitorcertain
physical processessuchastemperature,heartrate andmuscle tension,forexample.Thisinformationis
fedback byelectronicsignals,whichhelptospeedthe learningprocesssothatyouknow immediatelyif
the desiredeffecthasbeenachieved.
For instance,youmaybe connectedtoa device thatindicatesmuscletensionviaanelectronicsignal.
Thissignal increasesasyoutense anddecreasesasyourelax.Thisapproachis particularlyhelpful to
womenwithincontinence.Itraisesawarenessof andcontrol overpelvicfloormuscles.Byusing
electronicdevicestogauge bladderandurethral muscle contractions,youcanlearntocontrol and
strengthenthese muscles.Sometimesthe pelvicfloormusclesare strongbutare spasticor in spasmand
needtobe retrainedsotheyrelax appropriately.
Your therapistwill serveasa coach whoguidesandencouragesyouinvariousrelaxationtechniques,
self-regulation,self-awarenessandhome practices.Bypracticingthese techniques,yougaingreater
control overyour bodilyfunctions.Once yougaincompetence practicingatthe clinic,the ideaisto
become sogoodthat you no longerneedtobe monitoredbythe instrumentationora therapist.
In some clinicsyouare firsttaughtto close your eyesandfocusinwardto listentobodilychanges.After
you’re familiarwiththe technique,youare taughtto openyoureyesandfocuson the sounds,lightsor
computerdisplaytohelpfine-tuneskillslearnedwithyoureyesclosed.
Gradually,you’ll be able todothiswithoutthe audioorvisual aids.Justbyconcentration,youcan
contract and/orrelax certainmuscles.Atthatpoint,youcan use biofeedbackonyourown,withoutthe
equipmentandguidance of aclinicsession.
There are several basic methodsand instruments:
 Electromyography(EMG) measuresmuscle activity.Thisapproachisusedfora numberof
conditions,includingmuscle stiffness,stressincontinence,urge incontinence,overflow
incontinence,urinaryurgencyandfrequency,headaches,toothgrinding,stressandchronic
pain.It’salsousedwhenmusclesare healingorbeingreconditioned.Sensorsare usually
attachedto the affectedmuscles.
 Thermal biofeedbackprovidesinformationaboutskintemperature,anindicationof bloodflow.
You mighttake thisapproach if yousufferfrommigraines,Raynaud’sphenomenon,anxietyor
highbloodpressure.Sensorsoftengoonyourfingersor feet.

6.  Galvanicskinresponse trainingmeasureschangesinyourskin’ssurface—particularly
perspirationrates.Thisisacommonmethodfor dealingwithstress,phobiasandstuttering.
 Heart rate variabilitybiofeedback.Commonlyusedincommercial devices,thistype of
biofeedbackhelpsyoucontrol yourheartrate inorderto improve bloodpressure andlung
functionandto ease stressandanxiety.
 Respiration(rate,rhythmandtype of breathing) canbe monitored—oftenthroughastrain
gauge wrappedaroundyourchest or waist.Thismethodisoftenusedforasthma,
hyperventilation,anxiety,panicandanginawithchestpain.
 Electroencephalographs(EEG) (EEG) measure brainwaves.Ideally,anEEG will helpyoulearn
howto recognize andmodifyyourbrainwave activitybyidentifyingcertainbrainwavepatterns.
EEG biofeedback(alsocalledneurofeedback) canhelpimprove attentionandreduce impulsivity
and isusedto treat attentiondeficithyperactivitydisorder,headinjuriesandmilddepression.It
alsohas beenusedtotreat epilepsyanddepressionandtopromote recoveryfromheadinjuries
and stroke.Sensorsare placedonthe headin variouslocationsdependentonthe treatment.
In additiontothe actual biofeedback,yourtherapistwill probablyworkwithyouonrelaxation exercises,
stress-copingtechniques,deepbreathingandmuscle relaxation.
There alsoare biofeedbacktoolsavailableonline.While itisstill recommendedthatyoustartout
workingwithaprofessional,some of the new toolsmake iteasiertopractice at home.HeartMathoffers
software compatible withthe iPhone,iPad,iTouchandcomputersthatteachesyoutomonitoryour
bodysignalstobettermanage stress.The companyoffersonline trainingandworkswiththerapists
worldwide tohelpyougetstarted.
Many people learntocontrol variousfunctions,includingheartrate,bloodpressure andmuscle tension.
(Thisabilityenablessome peopletogooff certainmedications,suchasthose forbloodpressure and
milddepression.Butdon’tmake thisdecisionalone;talktothe prescribinghealthcare professional
before discontinuinganydrugregimen.)
Biofeedbacksuccessratesvarywidelybasedonthe individual andthe condition.There have been
numerouspublishedstudiesonthe efficacyof biofeedback,and researcherscontinue todofurther
studies.The practice isincreasinglygainingmainstreamacceptance withmore complexconditions.
Facts to Know
 Biofeedbackisn’tatreatmentora cure.It’sa setof techniquesormethodsforhelpingyou
become aware of your bodyprocessesinordertocontrol them.These changes,notthe
biofeedbackequipmentitself,are whatimprove yourhealth.
 Biofeedbackshouldneverbe usedfortreatingsymptomsthathaven’tbeencheckedoutbyyour
primaryhealthcare professional.
 Biofeedbackusesaudio,visualanddigital cuestoreflectchangesinyourphysiology.

7.  Biofeedbackisfrequentlyusedtohelppeoplewithstress-relateddisorders,insomniaand
chronicpain.Currently,over150 applicationsof biofeedbackhave beendescribedand
evaluated.
 The term “biofeedback”comesfrom“biological feedback”andcame intouse around1969.
 Biofeedbackisemergingasatherapyfor vulvovaginal pain.The rationaleisthe same asfor
incontinence—biofeedbackcanhelpyoutrainandstrengthen yourpelvicmuscles,whichinturn
can helpyoucontrol the muscle spasmsthat oftenaccompanythiscondition.Itisalsouseful in
helpingeliminate vaginismus,painfulvaginal spasmsoftenassociatedwithintercourse.
 Althoughbiofeedbacktherapyisnot licensedbythe state,youcan findaccreditedpractitioners
throughthe BiofeedbackCertificationInstituteof America(www.bcia.org).
 Biofeedbackcrossesmanyhealthcare categories.It’susedinseveraldisciplines,including
psychology,dentistry,physical therapy,painmanagementandinternal medicine.(Infact,some
nurses,physiciansanddentistsare alsobiofeedbacktherapists.)
 Researchersaren’texactlysure whybiofeedbackworks,butmostthinkthatlearninghow to
relax can helpthe patientlearnfrombiofeedback.Relaxationandstress-reductionexercisesare
an importantpart of biofeedbacktherapy.
 Biofeedbackispainless.
Key Q&A
1. I’mcurrentlyon medicationforthe same conditionforwhichI’mseekingbiofeedbacktherapy.
Will biofeedbacktake the place of these drugs?Itmight,butthiscan’tbe decidedwithout
careful evaluationof yourconditionandonlyinconjunctionwithyourphysician.Biofeedbackis
anothertool for youto use.Some people discoverthattheyare able tostop takingcertain
medicationsonce theymasterbiofeedback.Yourmedicationwill be continueduntilsuchtime as
youdemonstrate younolongerneedmedication,oritissafe to change your dosage.Whenyou
learnto control yoursymptoms,onlythenmayyourphysicianeliminateyourmedication.
2. I don’treallywantto try biofeedback,butmydoctorsaysit mighthelp.Idon’tbelieveher.DoI
needtotry?Tryingone sessionmightchange yourmind,butitdoesn’tcommityouto further
sessions.Afterone sessionyoucandecide whethertocontinue.If,afterthisfirstsession,you
are still reluctant,thendiscussitwithyourtherapistorreferringhealthcare professional.
Biofeedbackmaynotbe foryou.
3. I calleda biofeedbacktherapistandshe saidthatI neededtohave my regularhealthcare
professionalcheckoutmysymptomsfirst.Why?Biofeedbackisneverrecommendedfor
unevaluatedsymptoms.Forinstance,if youhave insomniaorchronicpain,that couldbe a
symptomof anothercondition.Andbiofeedback,byitself,isnotappropriate formany
conditions.Youneedtoknowwhat’swrongbefore youseektreatment.
4. I see at-home biofeedbackequipmentadvertisedonthe Web.ShouldItry that?Notwithout
runningitby yourbiofeedbacktherapistorhealthcare professional first.There are increasingly
more biofeedbackdevicesandprogramsthatare beingmarketedforhome use inthe formof
computersoftware andportable devices.Keepinmindthatsome of these productsmaynot be

8. reputable.Forbestresults,workwithatrained biofeedbacktherapistand/orcheckwithyour
healthcare professional before usinganyat-home biofeedbackprogramordevice.
5. Biofeedbackisconsideredanalternativetherapy.Doesthatmeanit’ssomehow spiritual?The
elementsof healthare consideredtoinvolve mind,bodyandspirit.Inthisinstance,spiritrelates
to an innersense of well-being,nottoanythingreligiousinnature.However,if youwishto
investigateadeeperspiritualconnection,youshouldfindatherapistproficientinthis
area.Biofeedbacktherapycanbe asinclusive asnecessaryinbringingahealthybalance into
your life.Thisinvolvesscientificallymeasuringspecificphysiological reactions,whichoccuras
youparticipate inyourlife.Take,forinstance,highbloodpressure.Biofeedbacktherapy
increasesyourawarenessof yourbloodpressure.Asyouthinkdifferentthoughtsorpractice
variousrelaxationtechniques,youcansee the resultsonthe monitororhear themviasounds
fromthe computer.Eventually,youlearnwhattodo to loweryourbloodpressure.
6. What do the machinesdo?What will itfeel like?The equipmentmerelymonitorsphysiological
changesand feedsthembacktoyou. The machinestransformthe dataintoimages,soundsor
digital information,allowingyoutomonitoryourbody’schanges.Youwon’tfeel anything
exceptthe electrodesbeingattachedtothe surface of your skinand removed.
For more informationvisitusourwebsite:http://www.healthinfi.com