2. Scheme of Presentation:
Introduction
Instrumentation
Mechanism
Applications of biofeedback
Psychiatric Implications
References
3. Definition:
Provision of information to a person regarding one or more physiological
processes in an effort to enable the person to gain some element of
voluntary control over bodily functions that normally operate outside
consciousness is known as Biofeedback
Biofeedback is a process that enables an individual to learn how to change
physiological activity for the purpose of improving health and performance
4. Leading Professional
Organizations
Association for Applied Psychophysiology and
Biofeedback(AAPB)
Biofeedback Certification International Alliance(BCIA)
International Society for Neurofeedback and
Research(ISNR)
5. Neal Miller(1969) published his pioneering paper “learning of visceral and
glandular responses” in which he reported that ,in animals ,various
visceral responses regulated by autonomic nervous system could be
modified through operant conditioning carried out in laboratory
This led to humans being able to learn to control involuntary physiological
responses
By means of instruments ,patients acquire information about the status of
involuntary biological functions and learn to regulate them through
biofeedback
7. Instrumentation:
The following are the most effective
instruments used in Biofeedback:
• EMG
• EEG
• Galvanic Skin Response gauge
• Thermistor
• Photoplethesmograph
• Respirometer
• Electrodermograph
8. The feedback instrument used depends on the patient and the
specific problem
Patients are attached to one of the instruments that measures
the physiological function and small changes in the physiological
levels of the feedback parameter are recorded and displayed
The display can be visual such as big meter or a bar of lights or
auditory
Patients are instructed to use the feedback from the display as
a guide to change the levels of the parameter
9. HOW BIOFEEDBACK WORKS
Biofeedback is an instrumental conditioning procedure
According to this view , feedback information rewards the
learners for specific physiological responses.
Other alternative explanations have been proposed by
Raczynski et al,1982.
1. Biofeedback teaches people skills in generalized relaxation
which lowers overall sympathetic nervous system activity
which inturn moves many physiological processes away from
overactivity
10. 2.Meichenbaum proposed that biofeedback effects are mediated by
Cognitions where people learn to control internal processes by using self-
statements or specific mental images which in-turn trigger specific
physiological reactions.
e.g. One headache victim learned to control her temporal artery blood flow
and stop her headache by picturing “a cameo lady from a soap
advertisement” in her mind.
11. Biofeedback Applications:
CONDITION METHOD OF FEEDBACK EFFECT
Asthma Frontal EMG
Airway Resistance
biofeedback
• Relaxation from the panic
associated with asthma
• Improvement of airflow
rate
Cardiac
arrhythmias
ECG biofeedback • To lower the frequency of
PVC
Fecal incontinence Triple lumen rectal
catheters
• in reestablishing normal
bowel habits
Grand mal epilepsy EEG Biofeedback • Used experimentally to
suppress seizure activity
prophylactically in patients
not responsive to
anticonvulsant
12. CONDITION METHOD OF FEEDBACK EFFECT
Migraine Thermal biofeedback from
a digit accompanied by
self suggestive phrases
encouraging hand
warming and head cooling
• Helps in preventing
excess cerebral
artery
vasoconstriction
Myofacial and TMJ
pain
EMG biofeedback • Reduction of pain
Tension headache EMG biofeedback • Patient learns to
relax the muscle
Raynaud’s
syndrome
Thermal feedback • To improve the
temperature of
hands and feet
Idiopathic
Hypertension and
Orthostatic
Hypotension
Blood pressure feedback
Galvanic skin response
Foot-hand thermal
feedback
• Decrease and
increase of Blood
pressure
13. Resperate is approved by U.S.FDA for reducing stress
and lowering Blood pressure
It is a portable electronic device that promotes slow,
deep breathing
It is intended to be used at least 15 minutes a day,3-4
days in a week
Within a few weeks ,the device guided slow breathing
exercises can help to lower both the systolic and
diastolic BP.
AHA says slow breathing is an effective add-on
treatment for people with high Blood pressure
14. Other conditions include
Vulvodynia
Urinary incontinence
Phantom limb pain
Bruxism
Constipation
Chronic pain
Fibromyalgia
Cognitive Rehabilitation of Traumatic brain injury
patient
To improve athletic performance
16. ADVANTAGES:
Non-invasive
It might enhance the benefits of medication
DISADVANTAGES:
Time consuming,takes months to show desired
improvement
Expensive
17. Neurofeedback
A form of biofeedback using brain scanning devices to provide feedback
about brain activity in an effort to modify behavior
Through operant conditioning
At first changes are short lived
By reconditioning and retraining the brain with continuing feedback ,
coaching and practice ,healthier brainwave patterns can usually be
retrained in most people
18. Each session lasts for 20-25 minutes once equipment is
attached
Number of sessions vary
15-20 sessions for anxiety or insomnia
For ADHD or learning disabilities,30-50 sessions
20. Specialized types of
Neurofeedback
Frequency/Power Neurofeedback
Slow Cortical Potentials Training
The Low Energy Neurofeedback System(LENS)
Homoencephalography
Z-score Neurofeedback Training
LORETA Neurofeedback Training
Functional MRI Neurofeedback
21. Frequency/Power
Neurofeedback
This technique typically includes the use of 2 to 4
surface electrodes
Also known as Surface Neurofeedback
Most frequently used neurofeedback techniques
It is used to change the amplitude or frequency of
specific brain waves in particular brain locations
22. Slow Cortical Potentials Training
These are the positive or negative polarizations of the EEG in the very
slow frequency range 0.3Hz to 1.5Hz
They maybe thought of as the direct current baseline on which the
alternating current EEG activity rides
There is generally a negative shift in direct current potentials that occur
during cognitive processing and positive slow cortical potentials occur
during inhibition of cortical networks
23. The Low Energy Neurofeedback
System(LENS)
Passive form of neurofeedback
Produces its effects through feedback that involves a
very tiny electromagnetic field which only has a field
strength of 10 watts/cm
It is delivered in 1 second intervals down the electrode
wires
The feedback is adjusted 16 times a second to remain
certain number of cycles faster than dominant
brainwave frequency
24. Advantages of LENS:
It seems to produce results faster than traditional
neurofeedback
Can be used with very young children
Can be used in individuals with poor motivation
25. Homoencephalography
Two approaches-near infrared and passive infrared
These are indirect measures of neural activity based on
neurovascular coupling
On the completion of the process patients learn to
increase cerebral blood flow to a specified region of
brain which helps in increasing the brain activity and
performance on tasks involving specific regions of the
brain
26. Z Score Neurofeedback
Training
It utilizes two , four or entire 19 electrodes
Continuous calculations are being computed comparing
the way that the brain is functioning on different
variables(e.g. power, asymmetries, phase-lag,
coherence) to a scientifically developed normative
database
Feedback is then based on these moment to moment
statistical comparisons to norms for the patients
approximate age group.
28. Neurometric brain mapping is a specialized QEEG approach that compares
EEG characteristics of the individual being evaluated with normative
database for same age
It helps in clarifying functional brain correlates
for cognitive impairment and yields info that
is useful for planning EEG Biofeedback
protocols addressing specific kinds of
dysfunction
29. LORETA Neurofeedback training
LORETA refers to low resolution electromagnetic
tomography
This is a kind of QEEG analysis that provides an
estimation of the location of patients EEG activity
within a frequency band
30. fMRI-Neurofeedback
It is a rather recent development for providing feedback training
based on blood oxygen concentration technique(BOLD)
It overcomes some limitations of more traditional forms of neuro-
feedback because of its better spatial resolution and can examine
functioning at deep subcortical areas of brain.
A promising technique for non-invasive psychiatric rehabilitation
because it allows patients in self regulating the activity of
relevant brain areas
31. Disadvantages of fMRI-
Neurofeedback
Incredibly expensive
Cost of equipment is high as well as extreme expenses
associated with day-to-day operation of such equipment
32. Relaxation therapy
Muscle relaxation is used as a component of treatment
programs (e.g., systematic desensitization) or as a
treatment in its own right (relaxation therapy).
Relaxation involves
(1) immobility of the body,
(2) control over the focus of attention,
(3) low muscle tone, and
(4) cultivation of a specific frame of mind, described as
contemplative, nonjudgmental, detached or mindful
33. Psychiatric implications:
HRV Biofeedback is a highly promising intervention for
reducing anxiety and stress
It can be tried as an adjunct intervention in
combination with other emperically supported
treatments(CBT)
This intervention is becoming increasingly more
attractive as a treatment aid with rapid improvements
and affordability of wearable devices(fitness trackers
and smart watches)
34. Neurofeedback has gained interest as a non pharmacological management
option for individuals suffering from OCD.
EEG studies in patients with OCD reported a widespread increase of slow
waves with additional report of epileptiform activities over left temporal
lobe
Q-EEG studies more often involved anterior regions of scalp supporting
hypothesis of frontal dysfunction in the pathogenesis of OCD
Cingulate gyrus in particular has been implicated as a locus of dysfunction
in Q-EEG studies
35. QEEG studies in psychiatric
disorders
Unipolar Depression Increase in alpha or theta
power
Generalised Anxiety Disorder Decrease in alpha
OCD Increase in theta
Panic attacks Paroxysmal activity
36. QEEG-guided biofeedback with ADHD and persons with
learning disability focussed on increasing the amount of
low beta microvolt activity and decreasing the amount
of high beta & theta microvolt activity across the
sensorimotor strip
37. Selecting a Qualified
Practitioner
Biofeedback training should be done under the
supervision of a qualified and certified professional who
will individualize the training.
A “one-size-fits-all” approach that is not tailored to the
individual will undoubtedly pose a greater risk of being
ineffective and at times may be even detrimental
38. References:
Introduction to Psychology by Morgan and king-Seventh
edition
Kaplan and Sadock’s Synopsis of Psychiatry-Eleventh edition
Kaplan and Sadock’s Comprehensive Textbook of Psychiatry-
Tenth edition
Len Ochs PhD (2006) The Low Energy Neurofeedback System
(LENS): Theory, Background, and Introduction, Journal of
Neurotherapy: Investigations in Neuromodulation,
Neurofeedback and Applied Neuroscience, 10:2- 3, 5-39
D. Corydon Hammond (2011): What is Neurofeedback: An
Update, Journal of Neurotherapy: Investigations in
Neuromodulation, Neurofeedback and Applied
Neuroscience, 15:4, 305-336.
39. Marzbani, H., Marateb, H. R., & Mansourian, M. (2016).
Neurofeedback: a comprehensive review on system
design, methodology and clinical applications. Basic and
Clinical Neuroscience, 7(2), 143-158.
Strehl, Ute(2009) 'Slow Cortical Potentials
Neurofeedback', Journal of Neurotherapy, 13: 2, 117 —
126
EMG-measures electrical potentials of muscle fibres,EEG-measures alpha waves that occur in relaxed states,GSR-skin conductivity’decresed in relaed state,thermistor-skin temperature which drops during tension because of peripheral vasoconstriction,ppg for periphera blood flow
