Biofeedback

What is Biofeedback?

http://www.youtube.com/watch?v=4Sin4QR4cwo

Biofeedback is a way to help people develop greater awareness and ability to regulate their physiological functioning by using signals from their own bodies with the goal of improving their wellbeing, health and performance.

Precise instruments measure physiological activity such as heart function, breathing, muscle activity, skin temperature and brain waves. These instruments “feedback” information to the user. This information helps to support desired physiological changes. Over time, these changes can endure without continued use of an instrument.

Common modalities of biofeedback include:

• Respiratory – measuring rate and pattern of breathing, as well as carbon dioxide levels in the blood

• Cardiovascular – measuring heart rate, heart rate variability, respiratory sinus arrhythmia and blood volume pulse.

• Neuromuscular – measuring muscle tension with surface electromyography (sEMG)

• Skin Conductance – measuring eccrine sweat gland activity.

• Peripheral Skin Temperature – measuring finger and/or toe temperature.

• Central nervous system (brain) – measuring brain wave signals (EEG) – generally referred to as neurofeedback.

The term Peripheral Biofeedback refers to all modalities of biofeedback except for biofeedback relating to the central nervous system (which is usually called neurofeedback or EEG biofeedback).

 Evidence for the effectiveness of Peripheral Biofeedback

Carolyn Yucha and Doil Montgomery in their book “Evidence – Based Practice in Biofeedback and Neurofeedback”, published in 2008, summarize the empirical evidence for use of biofeedback for various disorders.

The summary of levels of evidence is as follows:-

Level 1: Not empirically supported

• Anecdotal or case study evidence only

Level 2: Possibly efficacious

• At least one study of sufficient statistical power with well-defined outcome measures.
• No randomized assignment to a control condition.

Level 3: Probably efficacious

• Multiple observational, clinical, wait-list controlled, within-subject, and between-subject replication studies that demonstrate efficacy

Level 4: Efficacious

• At least two randomized controlled studies conducted in independent research settings

• Investigational treatment is shown to be statistically superior to a control condition or equivalent to  a treatment of established efficacy

• Sufficient power to detect moderate effect sizes

• Appropriate and well-defined inclusion criteria, diagnostic and treatment variables, outcome measures, and data analyses

Level 5: Efficacious and specific

• At least two independent studies meeting all criteria for level 4 show biofeedback treatment to be statistically superior to a placebo or an alternative treatment of established efficacy

 Psychophysiological disorders for which peripheral biofeedback has been shown to be efficacious. 

This list does not include all those disorders for which neurofeedback has been shown to be efficacious.  It should be noted that a significant amount of research has occurred since this book was published in 2008.  The next edition is likely to classify biofeedback for some disorders at a higher level of efficacy.

Level 2: Biofeedback is classified as possibly efficacious for the following disorders:

• Asthma

Heart rate variability (HRV) biofeedback and capnometry-assisted breathing training have been shown to be efficacious

• Chronic obstructive pulmonary disease (COPD)

HRV biofeedback and breathing pattern training have been shown to be efficacious

• Coronary artery disease

HRV biofeedback and psychosocial therapy with a biofeedback component have been shown to be efficacious

• Depressive disorders

HRV biofeedback and neurofeedback have been shown to be efficacious

• Fibromyalgia/chronic fatigue syndrome

Neurofeedback, HRV and surface electromyography (sEMG) biofeedback, in combination with exercise and cognitive-behavioral therapy, have been shown to be efficacious

• PTSD

HRV biofeedback and neurofeedback have been shown to be efficacious

• Repetitive strain Injury

sEMG and thermal biofeedback have been shown to be efficacious

• Tinnitus

sEMG biofeedback and neurofeedback have been shown to be efficacious

Level 3: Biofeedback is classified as probably efficacious for the following disorders:

• Arthritis

Thermal and sEMG biofeedback have been shown to be efficacious

• Diabetes

Thermal biofeedback has been shown to increase blood flow and improve healing to chronic foot ulcers

sEMG and thermal biofeedback have been shown to increase control over blood sugar

• Pediatric headache

sEMG, thermal biofeedback, and biofeedback-based relaxation training have been shown to be efficacious

• Insomnia

Relaxation-based biofeedback and neurofeedback have been shown to be efficacious

Level 4: Biofeedback is classified as efficacious for the following disorders:

• Anxiety

HRV, sEMG, SC, breathing and thermal biofeedback, and neurofeedback have been shown to be efficacious

• Chronic pain

HRV, sEMG, and thermal biofeedback, in combination with cognitive-behavioral therapy, have been shown to be efficacious.

• Hypertension

HRV, SC , and thermal and breathing biofeedback have been shown to be efficacious  

• Motion sickness

SC biofeedback has been shown to be efficacious

• Migraine headache

Thermal biofeedback has been shown to be efficacious

• Raynaud’s disease

Thermal biofeedback has been shown to be efficacious

• Temporomandibular joint disorders (TMJD)

sEMG biofeedback has been shown to be efficacious

Level 5: Biofeedback is classified as efficacious and specific for the following disorders:

• Adult tension headache

sEMG biofeedback and biofeedback-assisted relaxation have been shown to be efficacious

 

Recommended References

• For an introduction to the basics of biofeedback

Peper E., Tylova H., Gibney KH., Harvey R and Combatalade D.

“Biofeedback Mastery: An Experiential Teaching and Self Training Manual” AAPB., Wheat Ridge CO , 2009

• A more detailed and comprehensive guide to the practice of biofeedback

Khazan I.Z “The Clinical Handbook of Biofeedback – A step by step guide for training and practice with Mindfulness”. John Wiley and Sons, Oxford UK., 2013