Biofeedback Mastery

Biofeedback Mastery

Have you ever wondered what Biofeedback is all about? Uncover these unique information on Biofeedback! Are you in constant pain? Do you wish you could ever just find some relief? If so, you are not alone. Relieving chronic pain can be difficult and frustrating.

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One controlled electromyography (EMG) biofeedback (vs. sham biofeedback) study found a decrease in plasma adrenocorticotropic hormone and beta-endorphin levels during EMG biofeedback training (173). Other studies showed improvements in pain in FMS patients (174), whereas another showed the opposite (175). Another study found that the addition of exercise to biofeedback and relaxation training led to significantly greater and longer lasting improvements than either treatment alone (176).

Section Iii Therapy For Visceral Pain Scientific Basis And Practice Aspects

Psychological Interventions for Patients with Chronic Abdominal and Pelvic Pain 323 Luis F. Buenaver, Robert Edwards, and Jennifer A. Haythornthwaite Introduction 323 Biofeedback 324 Hypnosis 324 Cognitive Behavior Therapy . . . . 325 Multidisciplinary Treatment 326 Future Directions 326 References 327

Basic Bioinstrumentation System

Another important component, a feedback element, is not a part of all instrumentation systems. These devices include pacemakers and ventilators that stimulate the heart or the lungs. Some feedback devices collect physiological data and stimulate a response, e.g. a heart beat or breath, when needed or are part of biofeedback systems in which the patient is made aware of a physiological measurement, e.g. blood pressure, and uses conscious control to change the physiological response.

Financial Considerations

Neurofeedback treatment is administered in 1-hour sessions, 1 to 3 times per week for periods ranging from 3 months to more than 1 year, depending on the nature of the seizure disorder. The cost of treatment varies, but it is usually about 100 per session and is often covered by health insurance under the outpatient mental health benefit of the insurance, especially if the patient suffers from symptoms such as anxiety. Outpatient mental health benefits may have a deductible amount separate from that of the medical benefit. After the patient meets the deductible, the insurance covers from 50 to 80 of the usual and customary fees. The practitioner may charge an initial QEEG and intake consultation fee.

Practical Information

Biofeedback should be obtained from a trained therapist. Self-operated biofeedback devices are available, but biofeedback monitoring is a complex process that is most likely to be helpful when it is performed by a qualified practitioner. Biofeedback sessions typically last 30 to 60 minutes. The number of sessions required ranges from a few to 30 or 40. Health insurance sometimes provides coverage for this therapy. Many trained biofeedback therapists are psychologists. Certification is provided by the Biofeedback Certification Institute of America. Biofeedback practitioners can be found in the telephone directory under psychologists or by obtaining a directory of biofeedback therapists from the Biofeedback Certification Institute of America (, 10200 W. 44th Avenue, Suite 310, Wheat Ridge, CO 80033 (303-420-2902). An organization that provides biofeedback information and is involved in biofeedback research is the Association for Applied Psychophysiology and Biofeedback...

Meditation as an Intervention in Epilepsy

Excellent studies by Sterman, beginning in the 1970s (27), suggested and then proved that by modifying one's own specific EEG rhythm using EEG biofeedback, uneven brain wave activity in epilepsy could be enhanced and the seizure threshold raised (28). Thus, meditation and biofeedback can have a normalizing influence on EEG patterns. Later findings, however, confirmed that these EEG abnormalities could also be reduced using antiepileptic medication.

Various Behavioral and Cognitive Behavioral Treatments

A review 20 of clinical studies published from 1960 to 1985, concerning relief of pain using relaxation, biofeedback, hypnosis, placebo, TENS, and no treatment found that only biofeedback and relaxation achieved improvements greater than what was reported with no treatment . From these older studies, despite their lower quality, the consistent message is that patients who continue to practise what they learn are more likely to benefit from CBT, and that different behavioral techniques -cognitive behavioral, relaxation, and biofeedback-assisted relaxation, may all be effective for pain relief, improvement in mood, and coping skills.

Overview Review of the Literature

Secondly, as children with higher levels of distress, anxiety, depression, and negative life events are more likely to be at increased risk of long-term pain and disability 26, 27 . psychological treatments are also a key component of the bio-psychosocial model. These treatments include modalities such as biofeedback, relaxation training, and cognitive therapies and are often incorporated in order to target the effects of chronic pain on an individual 28 . These targets may include a child . s mood, fear of pain, fear of activity, acceptance of pain, and any thought process that might contribute to the disabling effects of pain on the child. Cognitive .behavioral treatment programs that focus on pain education, learning pain management strategies that help to reduce problematic behavioral patterns such as activity cycling and activity avoidance, and reducing pain-related distress, fear, anxiety, and depression have been found to be effective 29 .

Effectiveness of Music Therapy in Epilepsy

Lubar and Bahler (3) found that training individuals with severe seizure activity to use an EEG biofeedback of the sensorimotor rhythm could decrease seizure intensity and duration when the subjects learned to increase the 12- to 14-Hz EEG activity from the regions overlying the Rolandic area in the brain. This sensorimotor rhythm was hypothesized by Sterman (4) to be related to motor inhibitory processes.

Assessment of Effects of Meditation

Oxygen consumption and respiration following two yoga relaxation techniques. Appl Psychophysiol Biofeedback 2000 25 221-227. 23. Dunn BR, Hartigan JA, Mikulas WL. Concentration and mindfulness meditations unique forms of consciousness Appl Psychophysiol Biofeedback 1999 24 147-165. 29. Deepak KK, Manchanda SK, Maheshwari MC. Meditation improves clinicoelectroen-cephalographic measures in drug-resistant epileptics. Biofeedback and Self-Regulation 1994 19 25-40 (cited in Bulletin of Breakthroughs Los Angeles 1995 19 9 10). 33. Deepak KK, Behari M. Specific muscle EMG biofeedback for hand dystonia. Appl Psychophysiol Biofeedback 1999 24 267-280.

Complementary and Alternative Approaches

According to a recent national survey, 50 or more of patients who report severe depression have used complementary and alternative therapies in an attempt to alleviate symptoms (Kessler et al. 2001). These approaches include cognitive techniques such as relaxation and biofeedback, oral medications such as herbal medicine and homeopathy, physical treatments such as massage and chiropractic, and other approaches such as spiritual healing and dietary modification. Most persons using these approaches also seek treatment professionally (e.g., by a psychiatrist, psychologist, or general physician), which provides an opportunity to assess for possible adverse effects of combining alternative therapies with pharmacotherapies (e.g., mild serotonin syndrome from mixing St. John's wort and SSRIs). Clinicians need to inquire about the use of complementary and alternative approaches, become familiar with current data on efficacy, and inform patients of any potential known risks. A recent...

Nonpharmacological Treatment

The management of FMS patients is mostly based on empirical research, with only a few controlled studies (130). In a systematic review of MBTs for the treatment of FMS, MBT is more effective for some clinical outcomes as compared to being on a waiting list, treatment as usual, or placebo (131). However, when compared to active treatment, the results are largely inconclusive. Another study looked at complementary medical treatment for FMS (132). This report indicated that the strongest data was found for MBT (biofeedback and cognitive behavioral therapy), especially when part of a multidisciplinary approach. The weakest data was for manipulative techniques (chiropractic and massage).

The Role Of The Industry

Neurotechnology could be subdivided into neuropharmaceutical, neuro-device, and neurodiagnostic. Neuropharmaceutical can be further separated via its markets for cogniceutical, emoticeutical, sensoceutical, and neuro-nutraceutical, whereas neurodevice splits into markets for neuroprosthetic, neurostimulation, neurosurgical, and neurofeedback. Finally, neurodiagnostic gives rise to neuroimaging, in vitro diagnostics, and neuro-informatics (18)

Additional Readings Books

Biofeedback in the neurologic disorders. In Weintraub MI, Micozzi MS, eds. Alternative and Complementary Treatment in Neurologic Illness. New York Churchill Livingstone. 2001, pp. 156-165. Klarskov P, Heely E, Nyholdt I, et al. Biofeedback treatment of bladder dysfunction in multiple sclerosis. A randomized trial. Scand J Urol Nephrol Suppl 1994 157 61-65. Norton C, Hosker G, Brazzelli M. Biofeedback and or sphincter exercises for the treatment of faecal incontinence in adults (Cochrane review). In The Cochrane Library, Issue 2, 2000. Oxford Update Software. Wiesel PH, Norton C, Roy AJ, et al. Gut focused behavioural treatment (biofeedback) for constipation and faecal incontinence in multiple sclerosis. J Neurol Neurosurg Psychiatry 2000 69 240-243.

Comprehensive Neurobehavioral Approach

Donna Andrews experienced complex partial seizures (CPS) following acute encephalitis at age 18 years. Medications did not control her seizures and resulted in severe side effects, including the life-threatening allergic reaction Stevens-Johnson syndrome. Through careful observation, she developed techniques that allowed her to completely control her seizures. Donna Andrews met neurologist Joel Reiter in 1979, when she was his student in a course at the Berkeley Biofeedback Institute. After Dr. Reiter discussed his work with epilepsy patients using biofeedback, she challenged him to go further by incorporating the techniques she had developed to control her own CPS. He accepted the challenge and invited her to prove the efficacy of her methods by working in a pilot study directly with six of his patients with uncontrolled CPS (1). This study led to excellent results that have since been repeated with many other patients in the Andrews Reiter Epilepsy Program (2). The Andrews Reiter (A...

Studies in MS and Other Conditions

Biofeedback may have applications for multiple sclerosis (MS)-related symptoms. For anxiety and insomnia, which may be significant problems in MS, biofeedback may be beneficial by promoting relaxation. It also may be helpful in treating some types of pain, including tension headaches, migraines, and low back pain. However, the use of biofeedback to treat MS-associated pain has not been formally studied. Some research suggests that biofeedback may be helpful for people with urinary incontinence, a problem that may occur in MS. Medications and pelvic exercises are available for incontinence. These approaches may not be fully effective, however, and the medications may have undesirable side effects. Studies for biofeedback treatment of urinary incontinence have reported mixed results. Biofeedback may be especially effective for people who have difficulty knowing which muscles to contract during the performance of pelvic exercises. Studies must be done to more fully evaluate biofeedback...


Much of this book is devoted to methods of reducing stress and harmful responses to it. It is clear that there are many ways to achieve the same goal. Whether we use progressive relaxation, neurofeedback, yoga, exercise, or another method, consistency and comfort with the techniques are critical to ensure a lasting clinical response. As comprehensive epilepsy centers continue to embrace these techniques for their patients, more practitioners will become familiar with and sensitive to the special needs of people with epilepsy. Neurologists treating patients with seizures will also become more comfortable prescribing stress reduction therapies for their patients.

Chronic Pain

Likewise, cognitive-behavioral strategies are also valuable and are indicated for all pain problems, regardless of origin (104,105). These strategies are often helpful during acute pain suffering, and there are limited data on their efficacy for chronic pain, although anecdotally they seem to be effective. Strategies include meditation, distraction, use of biofeedback, and hypnosis. They may be taught by the primary care provider, a psychologist, or another skilled individual. If possible, this should occur during relatively pain-free periods and not in the middle of severe pain episodes.

Relevant Studies

We published the first results of the successful use of EEG biofeedback for epilepsy in 1972 (1). Work with the subject was based on biofeedback findings in animal studies that documented increased seizure thresholds in response to convulsive drugs. The patient, who had a 7-year history of generalized tonic-clonic seizures of unknown origin, became free of seizures after 3 months of training, a result that was startling given the seizure history. With a more prolonged period of treatment, this patient brought the seizures under control and stopped taking medications. Even though patients with epilepsy have different kinds of seizures, different histories, and take different medications, many controlled human studies on operant conditioning for seizure disorders were published in peer-reviewed medical journals between 1972 and 1996. These studies have consistently shown the benefits of operant conditioning (they are reviewed within Reference 15). Eighteen studies showed significant...


The author's use of hypnosis with aromatherapy is a unique approach to seizure reduction. Studies of hypnosis and epilepsy have been directed mainly at diagnosing nonepileptic or psychogenic seizure disorders. The safety of hypnosis for patients with epilepsy has not been well studied, but in the manner in which it is used by the authors, it would not seem all that different from many biofeedback protocols (see Chapter 7, Autogenic Training) and, therefore, it is unlikely to be of substantial risk.


Meditation is a simple and effective technique, but to use its full potential, certain steps should be assured. The basic instructions of meditation are easy, but these should be given after a good deal of explanation, preferably by an expert. If an expert teacher is not available, the teacher should be someone who has experienced the beneficial effect of meditation, either in terms of physiologic changes or psychologic manifestations. A certain receptivity is required for meditation, similar to that required for other behavioral techniques, such as hypnosis and biofeedback. Some amount of healthy skepticism is also useful, but the seeker should keep an open mind. At times, group practice, in which individuals learn to share their experiences, is more effective.

Relaxation Therapy

There are many different types of relaxation techniques which include meditation, mind body interaction, music- or sound-induced relaxation, mental imagery, and biofeedback. Rhythmic, deep, visualized or diaphragmatic breathing may also be used. Most studies of relaxation therapies are of poor quality and provide conflicting results. There is some evidence of short-term benefit in chronic low back pain for combined cognitive therapy and progressive relaxation therapy 28 . Mindfulness based stress reduction, a learned meditation technique that has been applied to many chronic psychological and physical health conditions, appears to be associated with significant and sustained improvements in pain intensity 29 , but has yet to be subjected to adequately sized randomized trials.


A review of migraine treatment - 13 found that the headache improvement rates for relaxation with biofeedback were similar to the improvement rates for pro- A review 14 of behavioral treatments for recurrent tension headache found that behavioral treatments resulted in a greater degree of headache improvement when compared to control conditions such as placebo biofeedback or headache self-monitoring. No significant difference in efficacy emerged in comparing one type of behavioral intervention with another (EMG biofeedback, relaxation training, or combined behavioral treatments). In 2002 the U.S. Headache Consortium published a series of meta-analyses concerning best evidence regarding medical and non-pharmacological treatment of acute and chronic headache. Campbell et al. 15 reviewed relaxation, feedback, cognitive behavioral treatment and various combinations. Relaxation techniques were found to be modestly, but significantly effective. There appeared to be no specific advantage for...

Treatment Method

Other, more formal, meditation methods include transcendental meditation, mindfulness meditation (or vipassana), and meditation techniques associated with Zen (the Chinese word for meditation) and yoga. Mindfulness meditation has been extensively described and researched by Dr. Jon Kabat-Zinn. The relaxation response also may be produced by hypnosis, guided imagery, biofeedback, and prayer, all of which are discussed in detail elsewhere in this book.


Well as decreased mood disturbance and anxious mood (Cruess et al., 2000a) in HIV-positive patients. A similar study demonstrated that behavioral stress management techniques such as self-induced relaxation using progressive muscle relaxation, electromyographic (EMG) biofeedback, self-hypnosis, and meditation resulted in improvement in anxiety, mood, and self-esteem (Taylor, 1995). Lutgendorf and colleagues (1998) also observed improvement in cognitive coping strategies, namely positive reframing and acceptance in addition to improvements in social supports.

Case Study

Clinically, there are many similarities in the diagnosis and the treatment of the MPS and sympathetically maintained pain. An interdisciplinary treatment approach is most effective in patients who have a history of chronic myofascial pain, especially if aspects of sympathetically maintained pain are also found. Physical therapy to break down the myofascial aspects of the pain is necessary, along with exercises to stretch, strengthen, and recondition the musculature and maintain normal joint and muscle mobility. The use of stress-loading activities may also be necessary, particularly if there is significant sympathetically maintained pain. Psychotherapy may be needed, along with stress management, including biofeedback-enhanced neuromuscular re-education and muscle relaxation. Neuropharmacological treatment is obviously also of extreme importance. The use of methodologies to deal with sympathetically maintained pain specifically may be needed to enable MPS to receive the needed therapy.


editation is a type of mind-body therapy, a class of therapies that also includes biofeedback, hypnosis, and guided imagery. For thousands of years, meditation has been practiced in some form, especially in the context of religious practice. Also, meditation is one of several components of some complementary and alternative medicine (CAM) therapies, including Ayurveda (which uses transcendental meditation or TM) and traditional Chinese medicine.