Biofeedback – A Worthy Consideration

General information on biofeedback

Biofeedback is described as a mind-body technique that utilises your mind to control your body’s physiological functions and responses; such as heart rate, breathing, skin temperature, perspiration, blood pressure, brain waves, and muscle tension. Biofeedback is considered a complementary or alternative type of therapy and is mainly used to help people relax, alleviate chronic pain, decrease stress, improve mental and physical performance, and manage a variety of conditions (see below).

Biofeedback has been used to address or treat the following medical conditions:

Anxiety disorder
Panic disorder
Sleep disorders
Attention-deficit hyperactivity disorder ( ADHD) and attention-deficit disorder (ADD)
Premenstrual syndrome ( PMS)
Bedwetting
Addiction to alcohol and other substances
Cardiac arrhythmias (abnormal heart rhythms)
Hypertension (high blood pressure)
Constipation and other digestive disorders
Faecal and urinary incontinence
Chronic pain
Temporomandibular joint disorders (TMD)
Epilepsy
Particular movement disorders
Paralysis
Spinal cord injury

How is biofeedback done?

A trained biofeedback therapist will interview clients, taking a medical history, current medications, and previous treatments undertaken. Then in conjunction with the client, create a list of goals and expected results.

Each biofeedback session, will involve the therapist placing biofeedback sensors on relevant areas of the body, which are dictated by the type of therapy undertaken, These sensors monitor and record the biological and physiological responses given by the body during the session. As the client learns to control their body’s physiologic functions, the biofeedback equipment will take note and signal the progress with a flashing light, tone, or pattern change on a screen.

The duration, frequency, and length of the sessions will vary from person to person and after each session, the therapist will review the progress made and draft a practice schedule for clients to work on at home. Consistency is critical as it will help to develop new neural pathways creating lasting results over time.

Note: If you are interested in trying Biofeedback, check with your doctor first and discuss any pre-existing medical conditions or other health concerns. Also, always check that any biofeedback therapist has the correct qualifications and experience.

Different Types of Biofeedback

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The type of biofeedback your therapist uses will depend on your medical condition or purpose. The most commonly used types of biofeedback are the following:

Temperature or thermal. Your hands and feet are sensitive to changes in temperature and stress levels. Your temperature goes down when you’re under a lot of stress because blood flow is redirected to vital organs (sympathetic nervous system or flight-or-fight response). Biofeedback takes advantage of this by using thermal sensors attached to your fingers or toes, which measure decreased blood flow to your skin. When you receive signals through the sensors that indicate stress or temperature changes, you can immediately start breathing and relaxation techniques. Medical conditions that can benefit from this include Raynaud’s disease and headaches.

An extensive systematic review of published studies done in 2006 on the effect of thermal biofeedback on Raynaud’s disease has revealed that most patients benefited from biofeedback and were able to raise the temperature in their fingers using the biofeedback technique. Raynaud’s disease is a disorder of the tiny blood vessels in your fingers and toes. These blood vessels constrict too much when you’re feeling stressed or cold, impeding blood flow to surrounding areas.
Brain waves. Scalp sensors are placed around your head to monitor brain waves using a machine called an electroencephalograph (EEG). People with ADHD and epilepsy benefit from this type of biofeedback. The use of an EEG machine in this type of biofeedback results in it often being referred to as neurofeedback. (Yes, experts really enjoy flooding us with complicated terms!)

An article published in the Journal of Clinical EEG & Neuroscience (2009) reported that meta-analysis of EEG biofeedback in treating people with epilepsy, found that its use produced a significant decrease in seizure frequency. This offers hope to those people who do not respond to traditional drug options, which can be as high as 30% of overall diagnosed cases.
Heart rate. Sensors from an electrocardiograph (ECG) machine are attached to your chest and extremities - such as your finger or earlobe, to measure heart rate changes or changes in blood flow, external and internal stimuli . This process is used in conjunction with such conditions as asthma, chronic obstructive pulmonary disease, anxiety, and people with arrhythmias (irregular heartbeat rate or rhythm).

The most common type of arrhythmia in Australia and New Zealand is atrial fibrillation (AF) - with over 360,000 people collectively living with this condition (www.healthnavigator.org.nz, 2017, www.mja.com.au, 2015). Atrial Fibrillation is a heart condition where the heart beats too fast or in an irregular way. A 2015 study, published in the Journal of Thoracic Disease, reported thatBiofeedback training appeared to help slow down the heart rate by increasing the parasympathetic nervous system activity.
Breathing. This type of Biofeedback uses straps applied around the chest and abdomen to monitor and record changes in breathing patterns and respiration rates. A 2015 study published in the European Respiratory Journal has successfully demonstrated that pulmonary rehabilitation exercises with integrated biofeedback can significantly improve compliance, along with adherence to regular exercise among patients with chronic obstructive pulmonary disease.
Muscle contraction. An electromyograph (EMG) is utilised to observe and measure the electrical activity and tension in your skeletal muscles by attaching sensors to them. It has several applications for incontinence, muscle retraining post-injury, back pain, anxiety disorders, and headaches.

A 2019 scientific article published in the International Journal of Clinical and Experimental Medicine, showed that EMG biofeedback-guided pelvic floor muscle training program among postpartum women with urinary incontinence, produced comparable results with Kegel exercises. Postpartum stress urinary incontinence is unconscious urination due to loss of muscular contraction in your pelvic floor muscles.
Sweat gland activity. An electrodermograph (EDG) is used by placing sensors on your fingers to monitor sweat gland activity and perspiration on your skin. This type of feedback is used for anxiety, pain, and recently, has been integrated with other treatments for seizures. EDG is sometimes referred to as electrodermal activity (EDA).

A study published in the Journal of Frontiers in Human Neuroscience (2015), showed that drugs combined with electrodermal biofeedback could significantly decrease the frequency of seizures and reduce the activation of the sympathetic nervous system (our fight or flight response) in patients diagnosed with grand mal seizure, with patients coping better with stress and anxiety after using biofeedback.

Advantages and Disadvantages of Biofeedback

Biofeedback is, on the whole, a safe and effective method of therapy but, should supplement your medical treatment, not replace it.

Advantages of biofeedback over other forms of alternative treatment include the following:

Biofeedback is non-invasive.
No significant preparations are needed before your biofeedback session. Just make sure you show up for the session and try not to break the biofeedback equipment.
No adverse side effects have been noted.
No medications are taken.
Biofeedback isn’t just a form of treatment. It’s also a process of training wherein the person undergoing it plays an active role to develop a skill. You’re an active learner and not just someone who opens his or her mouth and swallows a pill.

Disadvantages include:

Biofeedback therapy may not be for everyone. It requires time, motivation, effort, determination, commitment, and honest communication with your biofeedback therapist.
There are only a few qualified biofeedback therapists around, but don’t worry they’re numbers are increasing.

Biofeedback Practitioners

Practitioners of biofeedback need specific training. Presently, biofeedback isn’t regulated in Australia and New Zealand. Those who want to practice it are encouraged to meet (and maintain) the minimum standards of training. Assessment and accreditation to deliver biofeedback services will follow after training. The Biofeedback Certification International Alliance (BCIA) is an organisation based in the US that sets the minimum requirements to become a biofeedback practitioner.
Professionals who are certified by BCIA in biofeedback usually refer to themselves as Board Certified in Biofeedback (BCB). Most of its international practitioners are located in Australia, New Zealand, Canada, Europe, and Asia. Biofeedback societies and groups have been established in these countries and continents. Ideally, professionals who want to pursue a career in biofeedback should have experience and understanding in the field of health care. Examples of professionals who also practice biofeedback after certification include physicians, nurses, physical therapists, occupational therapists, psychologists, social workers, etc.

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While there is still much to be learnt and studied on the effectiveness of biofeedback on various medical conditions, we know that Biofeedback has numerous applications, but is best utilised and most effective when combined or integrated with your particular medical treatment. Therefore before starting on any type of biofeedback therapy, seek the advice of your primary healthcare provider or doctor, as different types of biofeedback can be incorporated with other treatments. And while Biofeedback is by no means a magic bullet by itself, it can give you a sense of control or empowerment over your own journey to wellness.