Progressive muscle relaxation and other relaxation techniques aim to reduce stress and anxiety in three ways: as a preventative measure, as a treatment for stress-related conditions, and as a coping skill. Relaxation methods target the autonomic nervous system, endocrine system, and skeletal musculature to induce a relaxation response. While early techniques like Jacobson's progressive muscle relaxation took significant time, modified versions like Bernstein and Borkovec's progressive relaxation training condensed the process into shorter sessions. Other approaches include passive muscular relaxation, applied relaxation, and breathing techniques. Relaxation training provides benefits for stress, hypertension, pain, insomnia, and other conditions.

1. RELAXATION AND
BIOFEEDBACK
PREPARED BY: DEEPANWITA ROY, 2ND YEAR M.PHIL TRAINEE, CLINICAL
PSYCHOLOGY CENTRE OF UNIVERSITY OF CALCUTTA

2. Theoretical background
 Sweeney (1978) defines ‘relaxation’ as ‘a positively perceived state or response
in which a person feels relief of tension or strain’. This includes psychological
aspects of the relaxation experience, such as the pleasant sensation and absence of
stressful or uncomfortable thoughts.
 Relaxation can be said to have three aims (Titlebaum, 1988):
 As a preventive measure, to protect body organs from unnecessary wear, an in particular,
the organs involved in stress-related disease (Selye, 1956, 1974)
 As a treatment, to help relieve stress in conditions such as essential hypertension (Patel &
Marmot, 1988), tension headache (Spinhoven et al., 1992), insomnia (Lichstein, 1983),
asthma (Henry et al., 1993), immune deficiency (Antoni et al., 1991), panic (Ost, 1988)
and many others.
 As a coping skill, to calm the mind and allow thinking to become clearer and more
effective. Stress can impair people mentally; relaxation can help to restore clarity of
thought. It has been found that positive information in memory becomes more accessible
when a person is relaxed (Peveler & Johnson, 1986).

3. Physiological Theories:
Body systems associated with the states of stress and relaxation include:
 The autonomic nervous system
 The endocrine system, and
 The skeletal musculature

4. The Autonomic Nervous System:
AUTONOMIC NERVOUS SYSTEM
Controls physiological arousal
SYMPATHETIC NERVOUS SYSTEM
Enables the body to cope with threat and
challenge
PARASYMPATHETIC NERVOUS SYSTEM
Restores a state of calm to the body
In a situation of challenge or excitement the sympathetic nervous system increases the activity of the heart and
redistributes blood from the viscera to the voluntary muscles. Blood pressure and respiratory rates are
increased; sensory awareness is heightened, and there is a mechanism for losing excess heat. These factors
enable the individual to make a physical response. The changes are collectively known as the ‘fight-flight
response’, which is characterized by an increase in:

5.  Heart rate
 Blood pressure
 Blood coagulation rate
 Blood flow to voluntary muscles
 Glucose content of the blood
 Respiratory rate
 Acuity of the senses
 Sweat gland activity
And a decrease of:
 Activity in the digestive tract.
In the absence of challenge or excitement, these actions are reversed: the sympathetic
nervous system loses its dominance and the parasympathetic assumes control.
The actions of these systems in greater details are shown in the following images:

8. The endocrine system:
Adrenal glands
Cortex
Glucocorticoids
(cortisol)
Function is to maintain the
fuel supply to the muscles.
It promotes the actions of
the catecholamines.
Medulla
Noradrenaline
Produce changes
associated with
aggression and
fighting behavior
Adrenaline
Associated with anxiety and
flight behavior; blood supply
to the leg is increased, feelings
of threat are experienced and
mental abilities are reduced
Under challenge, all the hormones are released. When the situation of challenge passes, and the
stress response is no longer needed, the parasympathetic nervous system produces the chemical
transmitter acetylcholine which brings about the reciprocal state, i.e. relaxation. The organs which
were previously activated are now at rest

9. The Skeletal Musculture
Jacobson (1938) proposed that the release of tension in the skeletal musculature
had the effect of calming the mind. The neuromuscular system is thus seen as a
mediator in the relief of stress and anxiety.

10. Psychological Theories:
Three types of psychological theory concerning relaxation are discussed in this section:
 Cognitive,
 Behaviour, and
 Cognitive-behaviour
Cognitive theories:
‘Our thoughts define our universe’ writes Piero Ferrucci in What We may BE (1982). The
way we view what happens to us determine how we feel about it. This idea optimizes the
cognitive approach which sees feeling as a function of thought. Interpretations,
perceptions, assumptions and conclusions will all give rise to particular feelings, which in
their turn govern our behaviour. Our experience of stress and anxiety is related to the way
we interpret events in our lives: we may for example, appraise situations in ways which
make them appear unnecessarily threatening.
Behaviour theories:
Behaviour theory, by contrast, is concerned with observable actions. Discounting what
goes on in the mind, it sees behaviour as conditioned by environmental events. Such
events are seen as leading the individual to act in predictable ways.

11. Behavioural approaches include: muscular relaxation, distraction, graded exposure and
social skills training.
Cognitive-behaviour theory:
Meichenbaum & Cameron (1974) were early proponents of the integration of cognitive
and behavioural techniques. Their aim was to promote behavioural change through the
restructuring of conscious thoughts, an approach which was further developed by
Meichenbaum (1977). Behaviour was seen as largely governed by the ‘self-talk’ in which
we engage. This is the internal dialogue we conduct with ourselves in order to interpret
the world. If the self-talk is positive, the outcome of a given task tends to be viewed in
positive terms; if the self-talk is negative, the outcome tends to be viewed in negative
terms. Positive self-talk leads to goal achievement and increased confidence, negative
self-talk to feelings of defeat. The approach was designed to give the individual a feeling
of greater control over his life and a protection against unnecessary stress.

12. The ‘specific effects’ hypothesis
and unitary theories
Anxiety can express itself in any of three
modes:
the somatic (physiological), the cognitive
(mental) and the behavioural (observable
actions).
The ‘specific effects’ hypothesis (Davidson
& Schwartz, 1976) states that a treatment
which operates in the presenting mode of
the anxiety will be more effective than one
which operates in a different mode; for
example, tension headache will be more
likely to respond to a somatic approach
such as releasing muscle tension than to a
cognitive one such as correcting faulty
thinking patterns. Thus training in one
mode is inappropriate if anxiety manifests
itself in another.
Somatic progressive relaxation,
applied relaxation,
Mitchell’s relaxation,
Breathing
Cognitive cognitive restructuring,
imagery,
self-statements,
meditations
Behavioural behavioural relaxation training
social skills
Cognitive and somatic autogenics

13.  In contrast, unitary theories propose a single, generalized relaxation effect
resulting from any one method. Benson’s ‘relaxation response’ (Benson et al.,
1974) is based on the hypothesis that all relaxation technique elicit a single,
common, generalized response.
 Jacobson’s progressive muscle relaxation is also based on a unitary theory, in
that the release of muscle tension is seen as creating a general state of
relaxation.

14. ‘Deep’ and ‘Brief’ relaxation
 Lichstein (1988) distinguishes between methods which create ‘deep relaxation’
and those which create ‘brief relaxation’.
 ‘Deep Relaxation’ refers to procedures which induce an effect of large
magnitude, and which are carried out in a calm environment with the trainee lying
down, e.g., progressive relaxation, autogenic training, meditation etc.
 ‘Brief Relaxation’ refers to techniques produce immediate effects and can be
used when the individual is faced with stressful events; the object here is the rapid
release of excess tension.
 Thus, whereas deep relaxation refers to a full process of total-body relaxation,
brief relaxation applies these procedures in everyday life.

15. Physical and Mental techniques
Physical techniques Mental techniques
Jacobson’s progressive muscle relaxation (1938)
Bernstein & Borkovec’s modified version (1973)
Everly & Rosenfeld’s passive relaxation (1981)
Madders’ release-only (1981)
Ost’s applied relaxation (1987)
Poppen’s behavioural relaxation training (1988)
The Mitchell method (1987)
Differential relaxation
Stretching
Exercise
Breathing methods
Self awareness
Imagery
Goal-directed visualization
Autogenic training (1969)
Meditation
Benson’s relaxation response (1976)

16. General aspects of relaxation
training:
 Aspects of relaxation training
which apply to all approaches are:
 Setting
 Establishing confidentiality
 Position (sitting/lying)
 Introducing methods to participants
(increasing interests and motivation)
 Delivery (tone of the voice)
 Termination (when and how)
 Homework (emphasize)
 Number of sessions
 The trainer/instructor/therapist (training
as a professional; experience and
practice)
 Supervisory back-up
 Pitfalls
 Autonomy of the individual

17. Jacobson’s Progressive Muscle
Relaxation
 Edmund Jacobson is a pioneer in this fields of research.
 It is a non-pharmacological method of deep muscle relaxation, based on the
premise that muscle tension is the body’s psychological response to anxiety-
provoking thoughts and that muscle relaxation blocks anxiety.
 The technique involves learning to monitor the tension in specific muscle groups by
first tensing each muscle group. This tension is then released, as attention is
directed towards the differences felt during tension and relaxation (Jacobson,
1938).
 Jacobson (1938) insisted that his method be regarded as a skill to be learned.
 The training session is conducted in a room that is quiet and darkened room with
the learner in a reclined position and eyes closed. The instructions begin by telling
the person to relax and just let go, detaching from thoughts or physical distractions
or trying to solve problems.

18.  Progressive muscle relaxation is suggested to be applied daily.
 The technique has its own top-down sequence, beginning with the upper body and
proceeding to the lower parts.
 Progressive muscle relaxation requires a high degree of personal motivation, as the
effects are often seen after prolonged sessions.

19.  Indications:
 Decrease in general anxiety
 Decreased in anticipatory anxiety related
to phobias
 Decrease in frequency and duration of
panic attacks
 Improved concentration
 In stress
 In hypertension
 Organic pain
 Chronic pain
 Insomnia
 Contraindications:
 High blood pressure
 Psychotic patients
 Severe depressed patients
 Jacobson used EMG to measure muscle tension and showed that JPMR has a direct
effect on the release of tension in the skeletal musculature; also it has an indirect
effect on anxiety levels, and that, via brain mediation, it promoted parasympathetic
dominance (Jacobson, 1938).
 The major disadvantages of JPMR is that it has methodological deficiency and relative
absence of statistical analysis and also its length and the time involved.
 As a result, these problems has led to plethora of modifications, which are explained in
the following slides.

20. Progressive Relaxation Training (PRT)
 Although Jacobson’s method was found to reduce pulse rate and blood pressure, it
was time consuming and unlikely to have wide appeal as it stood. So form of
abbreviation was needed.
 The first major attempt at shortening the format was made by Wolpe (1958), who
reduced the training to six sessions and later reduced it further to one.
 Countless other modifications have followed of which Bernstein & Borkovec’s
(1973) is one of the best known.
 This technique is named as “Progressive Relaxation Training” (PRT)
 This approach is defined as learning to relax specific muscle groups while paying
attention to the feelings associated with both the tensed and relaxed states. Its aims
are (Bernstein & Given, 1984):
 To achieve a state of deep relaxation in increasingly shorter periods
 To control excess tension in stress-inducing situations.
 The trainee works through the sequential tension and releasing of 16 muscle groups;
these are reduced to 7 in the next session and to 4 in a subsequent stage.

21. The difference between Jacobson’s progressive relaxation method and Bernstein & Borkovec’s Progressive
Relaxation Training (PRT):
Progressive Relaxation
(JPMR)
Progressive Relaxation Training (PRT)
Position of relaxation Lying or sitting Reclining
Total number of muscle
groups worked
48 16
Number of new muscle
groups worked in one session
1 or 2 all groups
Emphasis of technique Releasing tension ‘producing’ relaxation through tense-release cycles
Perceived value of the
contraction
To alert the individual to
the tension sensation
To deepen each relaxation component by providing a ‘running
start’; a strong contraction leads to a deep relaxation
Part played by suggestion None: technique is
purely a muscular skill
Indirect suggestion is used to enhance the effect
Use of tapes Not used Advised against
Number of sessions needed 50+ About 6

22. A tense-release script
 The script set out lies in the tradition of progressive relaxation. In procedure, however, it more
closely resembles progressive relaxation training, except that reduced effort to put into the
repeats in the manner of Jacobson’s diminishing tensions. The exercises themselves are drawn
from a variety of sources.
 The exercises include:
 Breathing 1
 Arm
 Leg
 Toe flexion (bending down and up)
 Breathing 2
 Abdominal muscle tensing
 Shoulder bracing
 Shoulder hunching
 Head pressing back
 Upper face (brow raising, frowning, eye exercises)
 Lower face (jaw, lips, tongue

23. Passive Muscular Relaxation
 Muscular relaxation is a process by which contractile tension in voluntary muscles is
reduced. The previous three are principally examples of the tense release techniques:
because of the contraction component, this is essentially an active procedure.
Relaxation performed without the contraction, however, is a passive
procedure.
 Passive muscle relaxation consists of a systematic review of the skeletal muscle groups
in the body. As attention is focused on each one in turn, the individual identifies any
tension and then releases it. Passive relaxation has certain practical advantages over
active methods in that:
1. The sequences can be carried out without drawing attention to the individual
performing them. They are thus potentially useful in the workplace or other public
locations where stress arises.
2. Passive routines take less time to work through than tense-release ones.
3. The method is available to those with physical disabilities, the nature of which
might preclude some of the tension routines.

24. Applied Relaxation
 The methods already discussed are concerned with whole/ deep relaxation; as such,
these methods are useful for unwinding after a stressful day, but may not, however,
provide strategies for coping with stress as it occurs. For this, a shortened version that
can be linked to life activities is required.
 Ost’s (1987) applied relaxation method, using progressive muscle relaxation as a core
technique teaches the individual to relax in successively shorter periods and to transfer
these relaxation effects to everyday situations. Thus the individual is equipped with a
strategy to control his reaction to stressful events as they occur.
 The method consists of six components:
 Tense-release technique (15-20minutes) (Wolpe & Lazarus, 1966)
 Release only technique (5-7minutes)
 Cue-controlled (conditioned) relaxation (2-3minutes)
 Differential relaxation (60-90seconds)
 Rapid relaxation (20-30seconds) and
 Application training.

25.  Ost’s method is designed for use with people
who suffer from panic and other kinds of
anxiety.
 Anxiety may be seen as having three aspects:
the physiological (such as, raised heart rate
and blood pressure, palpitations, sweating and
increased muscle tension), the cognitive
(negative thoughts, such as, ‘this is too much
for me to cope with’ or ‘I am going to have a
heart attack’) and the behavioural (by tense
posture and different kinds of unrelaxed
activity).
 Ost addresses these three modes of anxiety
with the applied relaxation approach:
 The physiological aspect is addressed
through muscle relaxation;
 The cognitive through the cue word; and
 The behavioural through differential
relaxation and exposure to the stressor.

26. Breathing
 Most relaxation methods, like imagery and the release of muscle tension, influence
the autonomic system by indirect routes.
 Breathing is different. It leads directly into the autonomic nervous system, a fact
which adds to its potential as a method of influencing physiological arousal (Lichstein,
1988).
 Breathing awareness exercises include:
 abdominal breathing (emphasizes the downward expansion of the chest cavity)
 breathing pouch (a variation of abdominal breathing, incorporates imagery)
 out tension, in peace,
 breathing meditation and
 breathing with cue words
 Breathing and relaxation:
 Respiration is directly linked with the ANS which controls physiological arousal.
 The techniques are easy to learn and can be carried out anywhere
 Breathing is particularly useful for those who find imagery difficult.

27. Self-Awareness
 ‘Being aware’ or ‘Being conscious’ convey similar ideas; however, their ideas on self is
very different. Being aware of the self is defined as ‘the tendency to focus attention
on the private aspects of the self’ (West, 1987).
 This signifies a process of self-exploration; a getting to know oneself.
 Authors have structured self-awareness in different ways: Burnard (1992) sees the
internal part as corresponding with Jung’s 4 functions of the mind (thinking, feeling,
sensing and intuiting), to which he adds a visceral component which includes muscle
tension and bodily relaxation. The external part refers to what other people see: our
verbal/non-verbal behaviour together with other aspects of the way we present
ourselves.
Inner
world
Thinking Intuition Feelings
Bodily
sensations
Intermediaryworld
ofthesenses
Seeing
Hearing
Smelling
Tasting
Touching
Outer world
Relating to
other people
Mental Approaches to relaxation:

28. Imagery
 Achterberg (1985) defines Imagery as ‘the thought process that invokes and uses the
senses’. Sight, sound, smell, taste, and touch modalities can all be involved in this activity,
which may take place in the absence of any external stimulus. It could be said that imagery is
thinking in pictures as opposed to thinking with words.
 Although the precise mechanism of imagery is unknown, it is believed to involve the right
cerebral hemisphere.
 Exercises which uses different kinds of imagery are as follows:
 Single sense imagery (sight, smell, sound, taste, touch, temperature, kinaesthetic senses)
 Imagery as symbol (Jung, 1963 remarked that symbols serve to connect to unconscious; they
are keys which can unlock the deeper parts of the psyche)
 Imagery as metaphor (metaphor itself, describes one thing in terms of another, offers a fresh
approach)
 Colour imagery
 Guided imagery (e.g., a meadow, forest, beach or garden)
 Imagery is a safe and non-invasive technique and it has been found to be successful in reducing
stress and anxiety (Donovan, 1980) and it also brings about about changes in the individual’s
perceptions (Dossey, 1988).

29. Goal-Directed Visualisation
 Fanning (1988) describes goal-directed visualization as ‘conscious, volitional
creation of mental sense impressions for the purpose of changing oneself’;
Shone (1984) refers to it as a mental experience which helps to bring about desired
outcomes.
 It can be seen that relaxation is related to goal-directed visualization in a variety of
ways:
 It is used as a preparatory measure to induce a state of mind conducive to
visualization.
 It may be experienced as a secondary effect following mental rehearsal
 Certain problems may create a need for relaxation while the goal is being achieved,
such as withdrawal from cigarettes or tranquilizers.
 Goal-directed visualization can be used in wide range of situations and conditions
associated with stress, such as performance fear, anger, problem solving and decision
making, eating disorders, agoraphobia and panic, alcohol and drug dependence.

30. Meditation
 People come for meditation for many reasons: to find peace, to achieve awareness, to
gain enlightenment, to find themselves and so on. Since relaxation is one of the
effects of all these pursuits, meditation is a relevant topic.
 Devotees of meditation claims that it has various advantages, such as, a better
understanding of the self, a new sense of relaxation and inner peace, the process
itself promotes clearer mind and improved powers of concentration, develops a sense
of detachment, and also emphasis on self-awareness.
 Focal points for mediation:
 The breathing
 Visual objects i.e., circle, mandala, candle, china bowl etc
 Parts of the body, i.e., space between the eyes, crown of the head, big toe
 Mantras
 Concentration on the breath is mentioned first for a number of reasons (Fontana,
1991): as it is constantly available, it has rhythmical quality, it is directly linked to the
autonomic system and it symbolizes the life force.

31. Bio-feedback
• Biofeedback is the process of gaining greater awareness of
many physiological functions primarily using instruments that provide information
on the activity of those same systems, with a goal of being able to manipulate
them at will (Durand, Vincent, Barlow, David, 2009).
• Biofeedback may be used to improve health, performance, and the physiological
changes which often occur in conjunction with changes to thoughts, emotions,
and behavior.

32. How does biofeedback therapy work?
 Most patients who benefit from biofeedback are trained to relax and modify their
behavior.
 Stressful events produce strong emotions, which arouse certain physical responses. Many
experts believe that these individual physical responses to stress can become habitual.
 Biofeedback is often aimed at changing habitual reactions to stress that can cause pain
or disease.
 Feedback of physical responses such as skin temperature and muscle tension provides
information to help patients recognize a relaxed state. The feedback signal may also act as
a kind of reward for reducing tension.
 Biofeedback procedures utilize electronic sensors that are almost entirely non-invasive for
monitoring physiological signals.
 During a biofeedback session, electrodes are attached to the skin. These electrodes send
signals to a monitor, which displays a sound, flash of light, or image that represents heart
and breathing rate, blood pressure, skin temperature, sweating, or muscle activity.
 When one is under stress, these functions change. The heart rate speeds up, muscles
tighten, blood pressure rises, one starts to sweat, and breathing quickens. One can see
these stress responses as they happen on the monitor as computer can filter the signals
and provide them in usable form, and then get immediate feedback as one would try to
stop them.

33. How biofeedback works. Diagram used with permission from Richard A. Sherman, of the Association for
Applied Psychophysiology and Biofeedback (AAPB).

34. How many sessions are needed:
 Each session generally lasts less than 1 hour.
 The number of sessions required depends on the condition being treated.
 Many people start to see results within 8 - 10 sessions.
 Treatment of headache, incontinence, and Raynaud's disease requires at least
10 weekly sessions and conditions like high blood pressure, however require
20 weekly sessions before improvement is seen.
 Along with biofeedback, usually mental exercises and relaxation techniques are
also taught that one can do at home for at least 5 - 10 minutes every day.

35. What happens before and after
biofeedback?
Before Biofeedback After Biofeedback
• Sympathetic arousal
• Beta activity in EEG
• Muscular constriction in EMG
• Shallow and rapid respiratory curves
in Pneumograph
• Increased resistance in GSR
• Vasoconstriction in thermal feedback
• Increased Noradrenalin secretion
• Para-sympathetic dominance
• Alpha activity in EEG
• Muscular relaxation in EMG
• Deep and regular respiratory curves
in Pneumograph.
• Decreased skin resistance in GSR
• Vasodilatation in Thermal feedback
• Acetylcholine secretion.

36. Biofeedback uses:
 Chronic pain-
By helping to identify tight muscles and then learn to relax those muscles, biofeedback
may help relieve the discomfort of conditions like low back pain, abdominal pain,
temporo-mandibular joint disorders (TMJ), and fibromyalgia. For pain relief, biofeedback
can benefit people of all ages, from children to older adults.
 Headaches-
Headaches are one of the best-studied biofeedback uses. Muscle tension and stress can
trigger migraines and other types of headaches, and can make headache symptoms
worse. Here Biofeedback seems to be especially beneficial for headaches when it's
combined with medications.
 Anxiety-
Anxiety relief is one of the most common uses of biofeedback. Biofeedback lets you
become more aware of your body's responses when you're stressed and anxious. Then
you can learn how to control those responses.

37.  Urinary Incontinence-
Biofeedback therapy can help people who have trouble controlling the urge to use the bathroom.
Biofeedback can help women find and strengthen the pelvic floor muscles that
control bladder emptying. After several sessions of biofeedback, women with incontinence may
be able to reduce their urgent need to urinate and the number of accidents they have.
Biofeedback can also help children who wet the bed, as well as people with fecal incontinence
(the inability to control bowel movements).
 High Blood Pressure-
Evidence on the use of biofeedback for high blood pressure has been mixed. Although the
technique does seem to lower blood pressure slightly, biofeedback isn't as effective as
medication for blood pressure control.
Other biofeedback uses include:
 Attention deficit hyperactivity disorder
 Chronic obstructive pulmonary disease
 Cardiovascular problem
 Raynaud's disease
 Diabetes
 Injury
 Asthma
 Constipation
 Anorexia nervosa
 Autism
 Depression
 Epilepsy and related seizure disorders
 Muscle spasms
 Sexual disorders, including pain with
intercourse
 Rheumatoid arthritis
 Sleep disorder
 Obsessive compulsive disorder (Seibert,
2012)

38. Types:
 Electromyograph (EMG):
• An electromyograph (EMG) uses surface electrodes to detect muscle action
potentials from underlying skeletal muscles that initiate muscle contraction.
• Clinicians record the surface electromyogram (SEMG) using one or more active
electrodes that are placed over a target muscle and a reference electrode that is
placed within six inches of either active. The SEMG is measured in microvolts
(millionths of a volt).
• Biofeedback therapists use EMG biofeedback when
treating anxiety and worry, chronic pain, essential
hypertension, headache (migraine, mixed headache, and tension-type
headache), low back pain, physical rehabilitation (cerebral palsy,
incomplete spinal cord lesions, and stroke), fecal incontinence, urinary
incontinence, and pelvic pain (Peper & Gibney, 2006; Yucha & Montgomery,
2008).

39.  Thermal biofeedback
• A feedback thermometer detects skin temperature with a thermistor (a temperature-sensitive resistor)
that is usually attached to a finger or toe and measured in degrees Celsius or Fahrenheit.
• Biofeedback therapists use temperature biofeedback when treating chronic
pain, edema, headache (migraine and tension-type headache), essential
hypertension, Raynaud’s disease, anxiety, and stress (Yucha & Montgomery, 2008).
 Neurofeedback or Electroencephalograph (EEG)
• Neurofeedback (NFB) is also called EEG biofeedback. It is a type of biofeedback that uses
real time displays of electroencephalography or functional magnetic resonance imaging
(fMRI) to illustrate brain activity, often with a goal of controlling central nervous
system activity.
• An electroencephalograph (EEG) measures the electrical activation of the brain from scalp
sites located over the human cortex. The EEG shows the amplitude of electrical activity at
each cortical site, the amplitude and relative power of various wave forms at each site, and
the degree to which each cortical site fires in conjunction with other cortical sites (coherence
and symmetry) (Kropotov, 2009).
• Neurofeedback training (NFT) uses monitoring devices to provide moment-to-moment
information to an individual on the state of their physiological functioning. The characteristic
that distinguishes NFT from other biofeedback is a focus on the central nervous system and
the brain.
• Neurotherapists use EEG biofeedback when treating addiction, attention deficit
hyperactivity disorder (ADHD),learning disability, anxiety
disorders (including worry, obsessive-compulsive disorder and posttraumatic
stress disorder), depression, migraine, and generalized seizures (Yucha &
Montgomery, 2008; Budzynski, Budzynski, Evans, & Abarbanel, 2009).

40.  Electrodermograph
• An electrodermograph (EDG) measures skin electrical activity directly (skin conductance
and skin potential) and indirectly (skin resistance) using electrodes placed over the digits
or hand and wrist. Orienting responses to unexpected stimuli, arousal and worry, and
cognitive activity can increase eccrine sweat gland activity, increasing the conductivity of
the skin for electrical current (Andreassi, 2007).
• Biofeedback therapists use electrodermal biofeedback when treating anxiety
disorders, hyperhidrosis (excessive sweating), and stress (Yucha & Montgomery,
2008; Moss, 2003).
• Electrodermal biofeedback is used as an adjunct to psychotherapy to increase client
awareness of their emotions (Toomim & Toomim, 1975; Moss, 2005).
 Photoplethysmograph (PPG)
• A photoplethysmograph (PPG) measures the relative blood flow through a digit using a PPG
sensor attached by a Velcro band to the fingers or to the temple to monitor the temporal
artery. This can measure blood volume pulse (BVP), which is the phasic change in blood
volume with each heartbeat, heart rate, and heart rate variability (HRV), which consists of
beat-to-beat differences in intervals between successive heartbeats (Lehrer, 2007; Peper,
Harvey, Lin, Tylova, Moss, 2007).
• Biofeedback therapists can use a photoplethysmograph to supplement temperature
biofeedback when treating chronic pain, edema, headache (migraine and tension-
type headache), essential hypertension, Raynaud’s disease, anxiety, and stress
(Yucha & Montgomery, 2008).

41.  Electrocardiograph (ECG):
• The electrocardiograph (ECG) uses electrodes placed on the torso, wrists, or legs, to measure
the electrical activity of the heart and measures the inter-beat interval.
• Biofeedback therapists use HRV(heartrate variability) biofeedback when treating asthma,
chronic obstructive pulmonary disease (COPD), depression, fibromyalgia, heart
disease and unexplained abdominal pain.
 Pneumograph
• A pneumograph or respiratory strain gauge uses a flexible sensor band that is placed around
the chest, abdomen, or both. The strain gauge method can provide feedback about the
relative expansion/contraction of the chest and abdomen, and can measure respiration
rate (the number of breaths per minute) (Stern, R. M., Ray, W. J., & Quigley, K. S. 2001).
• Biofeedback therapists use pneumograph biofeedback with patients diagnosed with anxiety
disorders, asthma, chronic pulmonary obstructive disorder (COPD), essential
hypertension, panic attacks, and stress (Yucha, C; Montgomery D (2008; Fried,
R.1987).
 Capnometer or capnograph, Rheoencephalograph (REG) or brain blood flow
biofeedback and Hemoencephalography or HEG biofeedback are also among the
few biofeedback techniques widely used in the treatment of various diseases.

42. Conclusion
Biofeedback provides tangible representation of subjective observations. Via the principles
of operant conditioning, self-regulation, and relaxation, biofeedback is a therapeutic
technology that empowers patients to be active participants in their own health care by
providing them with immediate insight into the functioning of their bodies.
Biofeedback’s various techniques are safe and adaptable for use by pediatric as well as
adult patients. Biofeedback is well established as an adjunctive treatment modality for
chronic pain conditions such as migraine, and support is accruing from recent studies of
the efficacy of biofeedback alone or in conjunction with other modalities for treating other
conditions, including ADHD, hypertension, and incontinence. In biofeedback the clients are
having self-control over their problems and are also getting immediate result which would
encourage its use among them. Moreover it covers wide range of disorders, so biofeedback
techniques can be the next widely used therapy.

43. Thank you!
CONTACT INFORMATION:
MS. DEEPANWITA ROY
CLINICAL PSYCHOLOGIST (RCI REGISTERED)
EMAIL ADDRESS: deepanwitaroycp@gmail.com