Biofeedback is a process that uses instruments to measure physiological functions like heart rate, skin temperature, and brain wave activity. This allows patients to learn how to control these involuntary functions. Dr. Chandana's presentation discussed the history, leading organizations, instrumentation, mechanisms, applications, and psychiatric implications of biofeedback. Common conditions it is used for include tension headaches, Raynaud's syndrome, hypertension, and anxiety. Neurofeedback is a specific type that uses brain scanning to modify brain activity through operant conditioning.

1. BIOFEEDBACK
Presenter:
Dr.S.Chandana,
Junior Resident.
Chairperson:
Dr.D.Vijaya lakshmi,
Assistant Professor,
Government
Hospital for Mental Care.

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

6. Involuntary biological functions include
 blood pressure
 heart rate
 skin temperature
 electrical conductivity
 Muscle tension
 Brain wave activity

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

15. Biofeedback in Psychiatric
conditions
 Generalized anxiety disorder
 OCD
 Stress
 Insomnia
 Unipolar Depression
 ADHD
 Learning disorders

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

19. EEG Frequency Bands
Delta Theta Alpha Low
beta
beta High beta gamma
1-4 hz 4-8 hz 8-12 hz 12-15
hz
15-20
hz
20-35 hz 35-40 hz

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.

27. 10-20 system of electrode placement:

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

40. THANK YOU