Biofeedback therapy training. Biofeedback Modalities

Interconnection of biofeedback different modalities

EMG Biofeedback. Electrode placement sites

EMG Biofeedback therapy training use in Orthopedics

Electrodermal Skin Activity Biofeedback therapy training

Hand temperature under various conditions

BIOFEEDBACK THERAPY TRAINING.
MODALITIES AND SPHERE OF USE

Biofeedback is a scientifically based method that uses monitoring instruments to measure and feedback information about physiological parameters of the body that out of conscious control: muscle tension, heart rate, breath, sweat responses, skin temperature, or brain activity. Terms associated with therapeutic biofeedback or biofeedback therapy training also viewed as a mind-body therapy method used in complementary and alternative medicine. Biofeedback is an important part of understanding the relationship between physical state and thoughts, feelings, and behaviors. Upon measurement parameters, biofeedback therapy training has various modalities and sphere of use.

Table of Contents

The purpose of biofeedback therapy training is to enhance an individual’s awareness of physical reactions to physical, emotional, or psychological stress, and their ability to influence their own physiological responses and to develop self-regulation skills that play a role in improving health and well-being.

Scientists cannot yet explain how exactly biofeedback works. Most patients who benefit from biofeedback are trained to relax and modify their behavior. Most scientists believe that relaxation is a key component in biofeedback treatment of many disorders, particularly those brought on or made worse by stress. Their reasoning is based on what is known about the effects of stress on the body. In brief, the argument goes like this: Stressful events produce strong emotions, which arouse certain physical responses. Many of these responses are controlled by the sympathetic nervous system, the network of nerve tissues that helps prepare the body to meet emergencies by “flight or fight.”

Patients may find it hard to accept that mental or psychological factors can cause diseases. Biofeedback facilitates the realization of “invisible influences” of the mind activated by thoughts, feelings or fears, especially for “skeptical patients”. This happens via objectively visible parameters onscreen. Thus, patients’ individual models of diseases open up to psychological causes.

Types of biofeedback therapy training modalities

Upon of the health problems and goals various physiological parameters can be measured and feedback for teaching self-regulation of these measuring parameters. And there is follow types of biofeedback upon of measuring and feedback parameters.

Electroencephalographic biofeedback (EEG BFB) or Neurofeedback

Sensors attached to the scalp monitors brain wave activity in different parts of the brain. It may be used to treat conditions with proven or suspected impact on brain wave patterns such as seizure disorders or epilepsy, ADHD, learning disabilities, migraine or tension headaches, traumatic brain injury, sleep disorders, and many others. It can also be used for reaching high performance in any sphere of human activity.
More detailed information regarding the Neurofeedback, indications for use and methodology, personal home used the device you can find in Therapeutic Neurofeedback page of this website. Stay informed regarding new applications of Neurofeedback, its use in different conditions, methodology, and effectiveness by following Articles page of this website.

Electromyographic biofeedback (EMG BFB)

When performing Electromyographic biofeedback therapy training the sensors/electrodes are placed on the skin on pertinent parts of the body to monitor electrical activity in muscles, specifically tension. This is the most frequently used biofeedback method in the treatment of various neurologic and neuromuscular disorders such as stroke, cerebral palsy, traumatic brain injury, and multiple sclerosis. Also, EMG BFB may be used to treat tension headaches, enuresis, and encopresis. In treating temporomandibular joint disorder (TMJ) or bruxism, EMG sensors are placed on jaw muscles. Chronic pain is treated by monitoring muscle tension in various places on pertinent parts of the body. It can be also used to treat clubfoot, malposture, tics and other conditions in children.
More detailed information regarding the EMG BFB, indications for use and methodology, personal home use device you can find in EMG BFB page of this website. Stay informed regarding new applications of EMG BFB, its use in different conditions, methodology, and effectiveness by following Articles page of this website.

Breathing biofeedback

During respiratory biofeedback therapy training, bands are placed around the abdomen and chest to monitor the breathing pattern, respiration rate and teach a conscious abdominal (diaphragmatic) breathing. This quick-to-learn technique helps the patient to actively respond to stress and strain. Breath control training may be used to treat panic attacks, asthma, and a variety of stress-related conditions including professional performance anxiety.
More detailed information regarding the breathing biofeedback, indications for use and methodology, personal home use device you can find in Breathing Biofeedback page of this website. Stay informed regarding new applications of breathing biofeedback, its use in different conditions, methodology and effectiveness by following Articles page of this website.

Heart rate variability biofeedback (HRV BFB)

When performing HRV biofeedback therapy training a pulse sensor/electrode placed on the fingertip monitors pulse rate. Increases in heart rate are associated with emotional arousal, such as being angry or fearful. Decreases in heart rate are associated with relaxation.
The magnitude and the complexity of Heart Rate Variability are indicators of the efficiency of autonomic regulation in response to internal and environment demands. HRV reflects the action of several systems working together. Low HRV is associated with: all-causes of mortality and sudden death in myocardial infarction, Hypertension, Fibromyalgia, Depressive symptomatology, Anxiety symptoms, Generalized anxiety disorders, PTSD, Panic disorders, Insomnia, and many others.

HRV BFB was conceived as an intervention that would target the parasympathetic nervous system (PNS). The HRV BFB training influence to the organism through the three possible mechanisms: 1. affecting cardiovascular homeostatic reflexes so as to increase flexibility and recovery from fight/flight adaptive situations; 2. the vagal afferent pathways that stimulating by slow diaphragmatic breathing and may explain some of the central effects; 3. third pathway involves the cholinergic or parasympathetic systems regulating the inflammatory response.

HRV biofeedback applications: Asthma and Chronic Obstructive Pulmonary Disorder (COPD), Cardiovascular disease, Hypertension, Fibromyalgia. Major depressive disorder, Anxiety & PTSD, Abdominal pain and many others.

HRV biofeedback efficacy: in cardiovascular diseases – modestly lower in blood pressure, improvements in symptoms of heart failure with an increase in distance walked in 6-min walk test, emotional distress, etc; in Fibromyalgia – improvement in daily functioning, decreased report of pain and depressive symptoms, etc; in Depressive disorders – decrease in HR, increase in HRV, reduced anxiety & depression etc; in Anxiety disorders: reduced anxiety & anger symptoms, improved quality of sleep, etc; in Repetitive abdominal pain – reduced intensity and frequency of pain, effects mediated by changes in vagal tone.
HRV biofeedback Treatment is cost-effective and relatively brief (6-10 sessions) alternative/supplement to standard medical or psychiatric treatment.

More detailed information regarding the HRV BFB, indications for use and methodology, personal home use device you can find in HRV BFB page of this website. Stay informed regarding new applications of HRV BFB, its use in different conditions, methodology and effectiveness by following Articles page of this website.

Temperature or thermal biofeedback (Thermal BFB)

Thermal biofeedback therapy training works by attaching a temperature sensor or thermistor to a patient, normally the finger or hands. Sensors monitor body temperature and changes in blood flow. Temperature readout is then shown on a digital screen to the patient, who can track his or her body temperature by the minute. How tense a person is can be measured by a drop in temperature in their hands. This is because, during times of stress, the body will divert blood from the surface area of the body to the muscles and organs, allowing us to better respond to a nearby threat. This is also referred to as the “fight or flight” response. When our surface temperature is high, it typically means we are in a relaxed or sleepy state.

Temperature biofeedback may be useful for treating migraine headache, Raynaud’s disorder, and anxiety disorders. In fact, studies have shown that the use thermal biofeedback in the treatment of migraines can be more successful when used in combination with traditional migraine medications. When used consistently and under proper conditions, the practice of thermal biofeedback can be used to remedy the effects of stress and tension in the body. Besides helping to alleviate various medical issues, thermal biofeedback can also improve one’s mental state and overall mood. By improving one’s mood, a person will be able to perform at higher levels of concentration and subsequently, higher levels of success. This can be applied to job performance, athletics or even just day to day activities. Overall, thermal biofeedback is an effective and fairly inexpensive therapy for one to use, as a person can use it simply and within the comfort of their own homes. With just a little guidance and thorough practice, anyone can be able to use the technique to improve their physical state and being.

More detailed information regarding the Thermal BFB, indications for use and methodology, personal home use device you can find in Thermal BFB page of this website. Stay informed regarding new applications of Thermal BFB, its use in different conditions, methodology and effectiveness by following Articles page of this website.

Galvanic or electrodermal skin response (GSR BFB)

During Electrodermal skin activity biofeedback therapy training the sensors placed on the fingers to monitor perspiration or sweating physiological parameters that reflect the emotional state of individuals. This is also referred to as obtaining a skin conductance level (SCL). GSR may be used in the treatment of anxiety, fears or phobias, stress, and sleep problems.
More detailed information regarding the GSR BFB, indications for use and methodology, personal home use device you can find in Electrodermal activity BFB page of this website.
Stay informed regarding new applications of GSR BFB, its use in different conditions, methodology, and effectiveness by following Articles page of this website.

Goals of Biofeedback therapy training

1. Education about connections between patient’s symptoms and physiology,
2. Skills training in changing biofeedback signals corresponding to physiologic processes,
3. Development of awareness of internal states linked to arousal and relaxation,
4. Application of skills training to carry-over in recognizing and modifying internal states without the aid of instrumentation,
5. Development of a sense of self-efficacy and empowerment.

The various sphere of use of biofeedback

Biofeedback therapy training can be used by coaches and educators to help people function better and reach their high professional performance as by therapists for treatment of many various pathological states and disorders. Research has demonstrated that biofeedback can help in the treatment of many diseases and painful conditions.

Biofeedback has been used as a part of a comprehensive treatment approach with a number of conditions, including chronic pain, irritable bowel syndrome (IBS), temporomandibular joint disorder (TMJ), Raynaud’s syndrome, epilepsy, attention deficit hyperactivity disorder (ADHD), anxiety, migraine headaches, depression, traumatic brain injury, and sleep disorders. There is some support for using biofeedback in the treatment of diabetes when self-monitoring of blood glucose levels is maintained and within the context of regular physician consultation and supervision.

Biofeedback therapy training has been a useful tool in helping individuals with urinary incontinence regain bladder control by controlling the muscles used in urination. Sensors are placed in the vaginal or anal canal to help individuals learn when the muscles are properly contracted. A recent study found that this type of biofeedback treatment was safe, effective, and well-liked by women patients 55 years and older.

Conditions related to stress are also treated using biofeedback, such as certain types of headaches, high blood pressure, bruxism or teeth grinding, post-traumatic stress disorder (PTSD), eating disorders, substance abuse, and some anxiety disorders. In the treatment of stress-related conditions, biofeedback is often used in combination with relaxation training.

Sometimes, biofeedback is used to help individuals learn how to experience deeper relaxation, such as in childbirth education programs or general stress management. This is referred to as biofeedback-assisted relaxation training. Even for individuals who can achieve relaxation through other strategies such as meditation or relaxation, biofeedback can be a valuable added technique. Biofeedback offers special advantages, such as allowing the clinician to track closely the place where an individual tense up and help them to learn what thoughts and feelings are associated with the tension.

Stay informed regarding new applications of various type of biofeedback, its use in different conditions and disorders, methodology and effectiveness by following Articles page of this website.

Biofeedback for Relaxation Training

Biofeedback therapy training for Relaxation Training helps to consciously integrate phases of regeneration in daily routines. The learned techniques can reduce many psychosomatic symptoms and prevent the negative consequences of chronic stress. Relaxation may be achieved through biofeedback training sessions using breathing, heart rate, brainwave, skin temperature or muscle tension physiological parameters. The misguided effort, pressure to succeed, as well as, fear of losing control inhibits relaxation. Biofeedback allows clients to see their SUCCESS immediately onscreen by applying relaxation techniques. These have a positive and relaxing effect on the body – even absent of conscious perception. An expectation regarding self-efficacy also increases.
Before starting a relaxation treatment, it is useful to answer some question first:
• Which body system reacts most strongly to mental stress?
• Which body system shows a delayed recovery after the stressor?
• Which content triggers the strongest physiological response?
The physical reaction to stressors and the ability to relax after the stressor is objectively measured and tested and the psycho-physiological effects of certain contents (ideas, people, situations, images) is shown. Biofeedback can also be used to detect which relaxation technique is most appropriate for a patient.

Biofeedback therapy training in the treatment of Anxiety and Panic Disorders

Anxiety is a significant obstacle in the everyday life of people who suffer from this illness and can (partly) lead to massive psychological strain. Using Biofeedback as a therapeutic intervention method for anxiety disorders can be considered as a complementary therapy that supports the self-competence of patients and influences the progress of the therapy positively.
Biofeedback therapy training helps to make patients more aware of how their thoughts, feelings, and behaviors all interact. This is why it’s frequently used in conjunction with other therapies, including cognitive-behavioral therapy (CBT), or mindfulness meditation training, to reduce someone’s stress response.
As opposed to some forms of treatment, such as medications, biofeedback therapy is a process of training. Biofeedback teaches patients to pay more attention to the ways stress impacts the body. For example, anxiety causes someone’s heart rate to speed up (used HRV BFB), muscles to tense (can be used EMG biofeedback of m.frontalis) and the mind to worry (EEG biofeedback can be used). This, in turn, makes sleep and relaxation difficult. Through purposefully tracking symptoms and learning over and over again to reduce those using biofeedback as a guide, relaxation becomes better enforced.

Biofeedback therapy training in the treatment of Sleeping Disorders

Chronic sleeping disorders are often accompanied by stressful life events, increased general anxiety, depression, as well as anxiety relating to the disorder itself.
A common treatment method for insomnia involves the prescription of drugs. While offering satisfactory effects, on one hand, these drugs are accompanied by considerable drawbacks (deterioration of diurnal affectivity, addiction or increase in dose due to tolerance).
While sleeping pills should be prescribed only in addition to therapy, especially during a crisis, behavior-orientated therapies, such as biofeedback offer long-lasting effectiveness and lack possible side effects. Thus, biofeedback is regarded as first-line treatment.

Biofeedback therapy training in the Treatment of Pain

Chronic stress and tension often result in a vicious circle of tension and pain which leads to chronic pain disorders. Many patients are unaware that these tensions exist, they have become used to it.
Finding non-pharmacological techniques for controlling both short-term (acute) and chronic pain is now becoming more important than ever, especially if taking in consideration the fact that how much attention has been given to the potential for addiction of pain-killing drugs.
EEG biofeedback therapy training is being used in many treatment settings as an alternative method for pain reduction. It’s being used for things like management of strokes, post-traumatic events, headaches, injuries, chronic muscle tension, diabetic neuropathic pain, and cancer recovery. Some evidence shows that it takes about 40 to 60 training sessions to achieve the most benefits. Some studies show this amount can result in up to 70 percent less pain depending on the condition. Research studies suggest that it’s useful in both children and adults.
One of the most useful effects of biofeedback is to show individuals the status quo and make them aware of the cause of their pain. Biofeedback helps patients by learning conscious relaxation to break the vicious circle.
The following pain disorders are treated with biofeedback:

Biofeedback therapy training for headache and back pain

Throughout their lives, 70% of the population suffers from tension headaches, 15% from migraines. The German headache and migraine society mentions biofeedback as the most effective non-drug method for the treatment of this condition.
Because it can lower someone’s stress response, clinical studies have shown that biofeedback is effective in reducing the frequency and severity of tension and migraine headaches.
Multiple studies had shown a statistically significant decrease in the frequency and severity of the headaches in the first 12 months. This benefit continued for 36 months. Studies had also documented that biofeedback training allowed many patients to decrease their dependence on pain medications and less medical care costs.
More than 80% of individuals suffer from chronic back pain. Therapy trials showed that biofeedback had the biggest and most stable therapeutic results in the treatment of chronic back pain.
Through breath or EMG Biofeedback therapy training, the patients learn to consciously relax a different muscle group, which leads to a lower level of pain. In addition, improved body awareness is also useful in stress situations.

Biofeedback therapy training for Bruxism

Training and consolidation of general relaxation skills precede EMG biofeedback which will subsequently be collected of the masseter muscle, the m. temporalis and the m. frontalis in order to train discriminative perception of the muscles. This skill can be used to independently maintain a relaxed state of the affected muscles and to ensure to be lastingly free of symptoms.
Via biofeedback of the m. frontalis general relaxation is trained. After the consolidation of this skill, precise training will focus on discriminative muscle perception through different stress levels of the EMG signal. Increase in training, especially for bruxism alongside dental damage, is achieved via massaged practice to build-up a conditioned, reactive inhibition in accordance with additional training of relaxation and contraction of the m. masseter.

Biofeedback therapy training in the treatment of Spasmodic torticollis

EMG feedback therapy training is given bilaterally on the m. sternocleidomastoids in order to train both the reduction of tension as well as balancing both sternocleidomastoids muscles in accordance with increasing level of difficulty of the exercises along with advancement of therapy.
After general relaxation training (EMG biofeedback of m. frontalis or sternocleidomastoids) the exercises progress to bilateral biofeedback of the m. sternocleidomastoids. If patients achieve the goals of this phase of therapy (conscious reduction of tension of the affected muscle, balancing out both sternocleidomastoids muscles, contraction or relaxation of the non-affected sternocleidomastoids muscle), these skills can be trained under gradually increasing difficulty (while lying down, standing, sitting, moving, during a conversation, etc.). It is recommended for patients to practice at home with EMG home use devices as well (relaxation practices, movement exercises of the neck). Therapy should be concluded with booster sessions after six or 12 months.

Biofeedback therapy training in medicine

Many medical and psychological relevant indications can be treated with biofeedback. From adjuvant support to exposure therapy for anxiety and phobias, muscle-building exercises after strokes, to the widely documented effects on incontinence – Biofeedback is a useful therapy or support for many diseases.

Biofeedback therapy training in the treatment of essential hypertension

Essential hypertension covers all diseases concerning the regulation of blood pressure which lead to chronically increased blood pressure in the absence of organic causes. Hypertension is considered a major risk factor for cardiac infarction and stroke. Along with high cholesterol level and smoking, these constitute the major risk factors for cardiovascular and cerebrovascular diseases.
Practicing general relaxation techniques with Breathing biofeedback and HRV biofeedback patients are led to conscious variation in vascular resistance and increase in heart rate variability (RSA), which results in ongoing relief of the cardiovascular system and reduce blood pressure and subsequently facilitates medical treatment, increasing general well-being.
A 2011 study published in the Cleveland Clinic Journal of Medicine suggests that use of biofeedback-assisted stress management (BFASM) by heart failure patients may actually cause cellular and molecular remodeling of the failing heart, change abnormal heart rate variability and have a positive impact on side effects due to suffering from a serious chronic disease.

Biofeedback therapy training for the treatment of Morbus Raynaud

Raynaud’s Disease is a syndrome of the circulatory system, not of the skin. Morbus Raynaud is expressed through numbness, pain and low temperature in fingers and toes which can expand to the whole hand or foot as well as to the whole face in rare cases. The disease is related to dysfunctions of the peripheral blood supply leading to massive ischemia due to blood vessels constriction and slowing down blood. Small vessels that typically feed the skin with oxygen and warmblood constrict through a process called “vasospasm.” Because blood is not flowing freely to the extremities they turn white, then blue, and become cold and numb. Vasospasms are brought on by stress and cold, making winter especially difficult for those with the disease. According to a Danish study, 22% of women aged 21-50 years suffer from Morbus Raynaud.
Sufferers face two challenges: 1) to reduce the stress that might cause the initial vasoconstriction, and 2) to reverse the constriction once it occurs.
Thermal biofeedback therapy is an ideal treatment for such a condition, especially for someone who is unwilling to undertake traditional medical treatment or take prescription medications. Readings should always be taken in a neutral temperature room, in which one is neither hot nor cold. This will allow for the best feedback on body temperature. At first training of hand-warming is implemented under relaxation phases, afterwards, cold stimuli (room temperature, objects) are introduced and training continues.
A person will be able to perform thermal biofeedback readings on his or herself after proper training has been given by a specialist. Thermal biofeedback can also be performed at home. The constancy of training effects and therapeutic success can be achieved through training at home with personal use termal biofeedback device. A person would only need the proper equipment and a bit of patience and imagination, in this case, imagination to visualize conditions to help control body temperature. For example, someone could use mental visualization to imagine sitting in a cold room to help drop their temperature or vice versa. Children tend to be more successful in practicing thermal biofeedback at home because they are naturally more imaginative than adults.
Research by the Association for Applied Psychophysiology and Biofeedback shows thermal biofeedback is effective in the treatment of primary Raynaud’s Disease, with 80-90% of patients reporting improved circulation and a reduced frequency of symptoms, such as numbness, throbbing and swelling.
Patients learn to control the constriction and dilation of their blood vessels during about 20 training sessions.

Biofeedback therapy training for treatment of gastrointestinal disorders

Biofeedback for the treatment of Constipation

Biofeedback therapy is considered a well-established treatment modality for patients with several forms of chronic constipation (including dyssynergic defecation and fecal incontinence). Randomized controlled trials have found that 70 to 80 % of all patients undergoing specialized biofeedback training in treatment centers experience improvements in symptoms.

EMG biofeedback is used to help teach patients suffering from recurrent constipation to better sense and control muscles in their digestive system that are related to bowel movements. For example, impaired rectal sensation and poor ability to squeeze muscles in the abdomen are both corrected using biofeedback maneuvers.

Biofeedback for the treatment of incontinence

Biofeedback constitutes a very successful and effective method of treatment for urinary and fecal incontinence. The muscle tone of the pelvic floor can be measured using vaginal and rectal electrodes and is shown patients onscreen. The muscle can be trained in systematic sequences of contraction and relaxation. High success rates, absence of side effect and acknowledgment of patients’ active role in treatment sum up essential advantages of non-invasive and non-medicinal biofeedback therapy.

Biofeedback therapy training for Paresis and Paralysis

The purpose of training for patients with paresis or paralysis is efficient and extensive rehabilitation of as many as possible impaired functions due to damage to the central nervous system, damage to the spinal cord or nerve damage in the periphery. It was possible to prove the efficiency of Biofeedback under a great many specific applications. Particularly patients’ motivation increases with regard to visualizing residual activity in the EMG as well as accelerating treatment through systematic training.

Neurofeedback therapy training in the treatment of ADHD

Neurofeedback is a scientifically recognized method which can be applied to treat disorders related to decrease cognitive performance such as ADHD (attention deficit hyperactivity disorder) in order to increase the cognitive performance once again. Children suffering from ADHD often show a reduced attention span or an increased motoric activity leading to problems in school. As a result, these children might perform poorly at school despite some being very intelligent. Neurofeedback is a method of treatment featuring long-lasting therapeutic effects which are shown by several studies.
Neurofeedback is a non-invasive method using EEG feedback in order to restructure children’s neuronal networks which will subsequently improve symptoms. This is achieved through training of specific frequency bands that are different in children suffering from ADHD compared to healthy controls. “Frequency band training” means to report these parameters to the patients and to practice and consolidate an attentive yet relaxed state of mind with the aid of the specialist. Frequent training, as well as transferring exercises at home with home-use devices, ensure that children memorize this state of mind and are able to retrieve it in daily life.

EEG biofeedback is now commonly used to control symptoms of hyperarousal (class of symptoms that often impact people living with Post-Traumatic Stress Disorders), including insomnia. Research conducted in 2011 by the Department of Psychophysiology at Helfgott Research Institute in Oregon found that two forms of neurofeedback treatments (sensorimotor protocol and a sequential, quantitative EEG model) successfully demonstrated usefulness for treating insomnia symptoms. After undergoing 20 15-minute biofeedback sessions, both groups experienced significant decreases in dysfunctional symptoms like daytime sleepiness and hyperarousal during the night. The study participants also reported significant improvements in scores on insomnia several measurement scales (Insomnia Severity Index, Pittsburgh Sleep Quality Inventory, PSQI Sleep Efficiency Test, and Quality of Life Inventory).
More detailed information regarding the pathological states and condition in which can be effective the use of Neurofeedback, indications for use and methodology, personal home use device you can find in Neurofeedback page of this website.

Stay informed regarding new applications of Neurofeedback, its use in different conditions, methodology, and effectiveness by following Articles page of this website.

Learning biofeedback can take time and individual results depend on various factors including severity and chronicity of the condition, medication prescribed, presence of other concurrent medical factors, and ultimately, individual levels of motivation. Biofeedback can help a person to control symptoms of his/her condition or reduce the amount of medication. Eventually, everyone can practice the biofeedback techniques at own home comfort with the help of personal home use devices.

Biofeedback is considered safe. No negative side effects have been reported.