Biofeedback
Encyclopedia
Biofeedback is the process of becoming aware of various physiological
functions using instruments that provide information on the activity of those same systems, with a goal of being able to manipulate them at will. Processes that can be controlled include brainwaves
, muscle tone
, skin conductance, heart rate
and pain
perception.
Biofeedback may be used to improve health or performance, and the physiological changes often occur in conjunction with changes to thoughts, emotions, and behavior. Eventually, these changes can be maintained without the use of extra equipment.
Biofeedback has been found to be effective for the treatment of headache
s and migraine
s.
(AAPB), Biofeedback Certification Institution of America (BCIA), and the International Society for Neurofeedback and Research (ISNR), arrived at a consensus definition of biofeedback in 2008:
) 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
, computer-related disorder, essential hypertension
, headache
(migraine
, mixed headache, and tension-type headache), low back pain
, physical rehabilitation (cerebral palsy
, incomplete spinal cord lesions, and stroke
), temporomandibular joint disorder
(TMD), torticollis
, and fecal incontinence
, urinary incontinence
, and pelvic pain
.
(a temperature-sensitive resistor) that is usually attached to a finger or toe and measured in degrees Celsius or Fahrenheit. Skin temperature mainly reflects arteriole
diameter. Hand-warming and hand-cooling are produced by separate mechanisms, and their regulation involves different skills. Hand-warming involves arteriole vasodilation
produced by a beta-2 adrenegeric hormonal mechanism. Hand-cooling involves arteriole vasoconstriction
produced by the increased firing of sympathetic
C-fibers.
Biofeedback therapists use temperature biofeedback when treating chronic pain
, edema
, headache
(migraine
and tension-type headache), essential hypertension
, Raynaud’s disease
, anxiety
, and stress
.
In skin conductance, an electrodermograph imposes an imperceptible current across the skin and measures how easily it travels through the skin. When anxiety raises the level of sweat in a sweat duct, conductance increases. Skin conductance is measured in microsiemens (millionths of a siemens
). In skin potential, a therapist places an active electrode over an active site (e.g., the palmar surface of the hand) and a reference electrode over a relatively inactive site (e.g., forearm). Skin potential is the voltage that develops between eccrine sweat glands and internal tissues and is measured in millivolts (thousandths of a volt). In skin resistance, also called galvanic skin response
(GSR), an electrodermograph imposes a current across the skin and measures the amount of opposition it encounters. Skin resistance is measured in kΩ (thousands of ohms).
Biofeedback therapists use electrodermal biofeedback when treating anxiety disorders, hyperhidrosis
(excessive sweating), and stress
. Electrodermal biofeedback is used as an adjunct to psychotherapy to increase client awareness of their emotions. In addition, electrodermal measures have long served as one of the central tools in polygraphy (lie detection) because they reflect changes in anxiety or emotional activation.
The EEG uses precious metal electrodes to detect a voltage between at least two electrodes located on the scalp. The EEG records both excitatory postsynaptic potentials (EPSPs) and inhibitory postsynaptic potentials (IPSPs) that largely occur in dendrites in pyramidal cells located in macrocolumns, several millimeters in diameter, in the upper cortical layers. Neurofeedback
monitors both slow and fast cortical potentials.
Slow cortical potentials are gradual changes in the membrane potentials of cortical dendrites that last from 300 ms to several seconds. These potentials include the contingent negative variation
(CNV), readiness potential, movement-related potentials (MRPs), and P300
and N400 potentials.
Fast cortical potentials range from 0.5 Hz to 100 Hz. The main frequency ranges include delta, theta, alpha, the sensorimotor rhythm, low beta, high beta, and gamma. The specific cutting points defining the frequency ranges vary considerably among professionals. Fast cortical potentials can be described by their predominant frequencies, but also by whether they are synchronous or asynchronous wave forms. Synchronous wave forms occur at regular periodic intervals, whereas asynchronous wave forms are irregular.
The synchronous delta rhythm ranges from 0.5 to 3.5 Hz. Delta is the dominant frequency from ages 1 to 2, and is associated in adults with deep sleep and brain pathology like trauma and tumors, and learning disability.
The synchronous theta rhythm
ranges from 4 to 7 Hz. Theta is the dominant frequency in healthy young children and is associated with drowsiness or starting to sleep, REM sleep, hypnagogic imagery (intense imagery experienced before the onset of sleep), hypnosis, attention, and processing of cognitive and perceptual information.
The synchronous alpha rhythm ranges from 8 to 13 Hz and is defined by its waveform and not by its frequency. Alpha activity can be observed in about 75% of awake, relaxed individuals and is replaced by low-amplitude desynchronized beta activity during movement, complex problem-solving, and visual focusing. This phenomenon is called alpha blocking.
The synchronous sensorimotor rhythm
(SMR) ranges from 12 to 15 Hz and is located over the sensorimotor cortex (central sulcus). The sensorimotor rhythm is associated with the inhibition of movement and reduced muscle tone.
The beta rhythm consists of asynchronous waves and can be divided into low beta and high beta ranges (13–21 Hz and 20–32 Hz). Low beta is associated with activation and focused thinking. High beta is associated with anxiety
, hypervigilance
, panic
, peak performance, and worry
.
EEG activity from 36 to 44 Hz is also referred to as gamma. Gamma activity is associated with perception of meaning and meditative awareness.
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.
(PPG) measures the relative blood flow through a digit using a photoplethysmographic (PPG) sensor attached by a Velcro band to the fingers or to the temple to monitor the temporal artery. An infrared light source is transmitted through or reflected off the tissue, detected by a phototransistor, and quantified in arbitrary units. Less light is absorbed when blood flow is greater, increasing the intensity of light reaching the sensor.
A photoplethysmograph 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.
A photoplethysmograph can provide useful feedback when temperature feedback shows minimal change. This is because the PPG sensor is more sensitive than a thermistor to minute blood flow changes. 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
.
(distances between successive R-wave peaks in the QRS complex
). The interbeat interval, divided into 60 seconds, determines the heart rate at that moment. The statistical variability of that interbeat interval is what we call heart rate variability
. The ECG method is more accurate than the PPG method in measuring heart rate variability.
Biofeedback therapists use HRV biofeedback when treating asthma
, COPD, depression, fibromyalgia
, heart disease
, and unexplained abdominal pain
.
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). Clinicians can use a pneumograph to detect and correct dysfunctional breathing patterns and behaviors. Dysfunctional breathing patterns include clavicular breathing (breathing that primarily relies on the external intercostals and the accessory muscles of respiration to inflate the lungs), reverse breathing
(breathing where the abdomen expands during exhalation and contracts during inhalation), and thoracic breathing (shallow breathing that primarily relies on the external intercostals to inflate the lungs). Dysfunctional breathing behaviors include apnea
(suspension of breathing), gasping, sighing, and wheezing.
A pneumograph is often used in conjunction with an electrocardiograph (ECG) or photoplethysmograph
(PPG) in heart rate variability
(HRV) training.
Biofeedback therapists use pneumograph biofeedback with patients diagnosed with anxiety disorders, asthma
, chronic pulmonary obstructive disorder (COPD), essential hypertension
, panic attacks, and stress
.
uses an infrared detector to measure end-tidal (the partial pressure of carbon dioxide in expired air at the end of expiration) exhaled through the nostril into a latex tube. The average value of end-tidal for a resting adult is 5% (36 torr). A capnometer is a sensitive index of the quality of patient breathing. Shallow, rapid, and effortful breathing lowers , while deep, slow, effortless breathing increases it.
Biofeedback therapists use capnometric biofeedback to supplement respiratory strain gauge biofeedback with patients diagnosed with anxiety disorders, asthma
, chronic pulmonary obstructive disorder (COPD), essential hypertension
, panic attacks, and stress
.
(REG), or brain blood flow biofeedback, is a biofeedback technique of a conscious control of blood flow. An electronic device called a rheoencephalograph [from Greek rheos stream, anything flowing, from rhein to flow] is utilized in brain blood flow biofeedback. Electrodes are attached to the skin at certain points on the head and permit the device to measure continuously the electrical conductivity of the tissues of structures located between the electrodes. The brain blood flow technique is based on non-invasive method of measuring bio-impedance. Changes in bio-impedance are generated by blood volume and blood flow and registered by a rheographic device. The pulsative bio-impedance changes directly reflect the total blood flow of the deep structures of brain due to high frequency impedance measurements.
or HEG biofeedback is a functional infrared
imaging technique. As its name describes, it measures the differences in the color of light reflected back through the scalp based on the relative amount of oxygenated and unoxygenated blood in the brain. Research continues to determine its reliability, validity, and clinical applicability. HEG is used to treat ADHD and migraine
, and for research.
Kegel
developed the perineometer in 1947 to treat urinary incontinence (urine leakage) in women whose pelvic floor muscles are weakened during pregnancy and childbirth. The perineometer, which is inserted into the vagina to monitor pelvic floor muscle contraction, satisfies all the requirements of a biofeedback device and enhances the effectiveness of popular Kegel exercises.
Research has shown that biofeedback can improve the efficacy of pelvic floor exercises and help restore proper bladder functions. The mode of action of vaginal cones, for instance involves a biological biofeedback mechanism . Studies have shown that biofeedback obtained with vaginal cones is as effective as biofeedback induced through physiotherapy electrostimulation.
In 1992, the United States Agency for Health Care Policy and Research recommended biofeedback as a first-line treatment for adult urinary incontinence.
recorded spontaneous electrical potentials from the exposed cortical surface of monkeys and rabbits, and was the first to measure event-related potentials (EEG responses to stimuli) in 1875.
Danilevsky published Investigations in the Physiology of the Brain, which explored the relationship between the EEG and states of consciousness in 1877.
Beck
published studies of spontaneous electrical potentials detected from the brains of dogs and rabbits, and was the first to document alpha blocking, where light alters rhythmic oscillations, in 1890.
Sherrington
introduced the terms neuron
and synapse
and published the Integrative Action of the Nervous System in 1906.
Pravdich-Neminsky
photographed the EEG and event related potentials from dogs, demonstrated a 12–14 Hz rhythm that slowed during asphyxiation, and introduced the term electrocerebrogram in 1912.
Forbes reported the replacement of the string galvanometer with a vacuum tube to amplify the EEG in 1920. The vacuum tube became the de facto standard by 1936.
Berger
(1924) published the first human EEG data. He recorded electrical potentials from his son Klaus's scalp. At first he believed that he had discovered the physical mechanism for telepathy but was disappointed that the electromagnetic variations disappear only millimeters away from the skull. (He did continue to believe in telepathy throughout his life, however, having had a particularly confirming event regarding his sister). He viewed the EEG as analogous to the ECG and introduced the term elektenkephalogram. He believed that the EEG had diagnostic and therapeutic promise in measuring the impact of clinical interventions. Berger showed that these potentials were not due to scalp muscle contractions. He first identified the alpha rhythm, which he called the Berger rhythm, and later identified the beta rhythm and sleep spindles. He demonstrated that alterations in consciousness are associated with changes in the EEG and associated the beta rhythm with alertness. He described interictal activity (EEG potentials between seizures) and recorded a partial complex seizure in 1933. Finally, he performed the first QEEG, which is the measurement of the signal strength of EEG frequencies.
Adrian
and Matthews confirmed Berger's findings in 1934 by recording their own EEGs using a cathode-ray oscilloscope. Their demonstration of EEG recording at the 1935 Physiological Society meetings in England caused its widespread acceptance. Adrian used himself as a subject and demonstrated the phenomenon of alpha blocking, where opening his eyes suppressed alpha rhythms.
Gibbs
, Davis
, and Lennox inaugurated clinical electroencephalography in 1935 by identifying abnormal EEG rhythms associated with epilepsy, including interictal spike waves and 3 Hz activity in absence seizures.
Bremer used the EEG to show how sensory signals affect vigilance in 1935.
Walter
(1937, 1953) named the delta waves and theta waves, and the contingent negative variation
(CNV), a slow cortical potential that may reflect expectancy, motivation, intention to act, or attention. He located an occipital lobe
source for alpha waves and demonstrated that delta waves can help locate brain lesions like tumors. He improved Berger's electroencephalograph and pioneered EEG topography.
Kleitman has been recognized as the "Father of American sleep research" for his seminal work in the regulation of sleep-wake cycles, circadian rhythms, the sleep patterns of different age groups, and the effects of sleep deprivation
. He discovered the phenomenon of rapid eye movement (REM) sleep with his graduate student Aserinsky in 1953.
Dement, another of Kleitman's students, described the EEG architecture and phenomenology of sleep stages and the transitions between them in 1955, associated REM sleep with dreaming in 1957, and documented sleep cycles in another species, cats, in 1958, which stimulated basic sleep research. He established the Stanford University Sleep Research Center in 1970.
Andersen and Andersson (1968) proposed that thalamic pacemakers project synchronous alpha rhythms to the cortex
via thalamocortical circuits.
Kamiya (1968) demonstrated that the alpha rhythm in humans could be operantly conditioned. He published an influential article in Psychology Today that summarized research that showed that subjects could learn to discriminate when alpha was present or absent, and that they could use feedback to shift the dominant alpha frequency about 1 Hz. Almost half of his subjects reported experiencing a pleasant "alpha state" characterized as an "alert calmness." These reports may have contributed to the perception of alpha biofeedback as a shortcut to a meditative state. He also studied the EEG correlates of meditative states.
Brown (1970) demonstrated the clinical use of alpha-theta biofeedback. In research designed to identify the subjective states associated with EEG rhythms, she trained subjects to increase the abundance of alpha, beta, and theta activity using visual feedback and recorded their subjective experiences when the amplitude of these frequency bands increased. She also helped popularize biofeedback by publishing a series of books, including New Mind, New body (1974) and Stress and the Art of Biofeedback (1977).
Mulholland and Peper (1971) showed that occipital alpha increases with eyes open and not focused, and is disrupted by visual focusing; a rediscovery of alpha blocking.
Green and Green (1986) investigated voluntary control of internal states by individuals like Swami Rama and American Indian medicine man Rolling Thunder both in India and at the Menninger Foundation
. They brought portable biofeedback equipment to India and monitored practitioners as they demonstrated self-regulation. A film containing footage from their investigations was released as Biofeedback: The Yoga of the West (1974). They developed alpha-theta training at the Menninger Foundation from the 1960s to the 1990s. They hypothesized that theta states allow access to unconscious memories and increase the impact of prepared images or suggestions. Their alpha-theta research fostered Peniston's development of an alpha-theta addiction protocol.
Sterman (1972) showed that cats and human subjects could be operantly trained to increase the amplitude of the sensorimotor rhythm
(SMR) recorded from the sensorimotor cortex. He demonstrated that SMR production protects cats against drug-induced generalized seizures (tonic-clonic seizures involving loss of consciousness) and reduces the frequency of seizures in humans diagnosed with epilepsy
. He found that his SMR protocol, which uses visual and auditory EEG biofeedback, normalizes their EEGs (SMR increases while theta and beta decrease toward normal values) even during sleep. Sterman also co-developed the Sterman-Kaiser (SKIL) QEEG database.
Birbaumer and colleagues (1981) have studied feedback of slow cortical potentials since the late 1970s. They have demonstrated that subjects can learn to control these DC potentials and have studied the efficacy of slow cortical potential biofeedback in treating ADHD, epilepsy, migraine, and schizophrenia.
Lubar (1989) studied SMR biofeedback to treat attention disorders and epilepsy in collaboration with Sterman. He demonstrated that SMR training can improve attention and academic performance in children diagnosed with Attention Deficit Disorder with Hyperactivity (ADHD). He documented the importance of theta-to-beta ratios in ADHD and developed theta suppression-beta enhancement protocols to decrease these ratios and improve student performance.
Tarchanoff used the endosomatic method by recording the difference in skin electrical potential from points on the skin surface in 1889; no external current was applied.
Jung
employed the galvanometer
, which used the exosomatic method, in 1907 to study unconscious emotions in word-association experiments.
Marjorie and Hershel Toomim (1975) published a landmark article about the use of GSR biofeedback in psychotherapy.
(1930) developed hardware to measure EMG voltages over time, showed that cognitive activity (like imagery) affects EMG levels, introduced the deep relaxation method Progressive Relaxation, and wrote Progressive Relaxation (1929) and You Must Relax (1934). He prescribed daily Progressive Relaxation practice to treat diverse psychophysiological disorders like hypertension.
Several researchers showed that human subjects could learn precise control of individual motor units (motor neurons and the muscle fibers they control). Lindsley (1935) found that relaxed subjects could suppress motor unit firing without biofeedback training.
Harrison and Mortensen (1962) trained subjects using visual and auditory EMG biofeedback to control individual motor units in the tibialis anterior muscle of the leg.
Basmajian (1963) instructed subjects using unfiltered auditory EMG biofeedback to control separate motor units in the abductor pollicis muscle of the thumb in his Single Motor Unit Training (SMUT) studies. His best subjects coordinated several motor units to produce drum rolls. Basmajian demonstrated practical applications for neuromuscular rehabilitation, pain management
, and headache treatment.
Marinacci (1960) applied EMG biofeedback to neuromuscular disorders (where proprioception
is disrupted) including Bell Palsy (one-sided facial paralysis), polio, and stroke
.
"While Marinacci used EMG to treat neuromuscular disorders, his colleagues only used the EMG for diagnosis. They were unable to recognize its potential as a teaching tool even when the evidence stared them in the face! Many electromyographers who performed nerve conduction studies used visual and auditory feedback to reduce interference when a patient recruited too many motor units. Even though they used EMG biofeedback to guide the patient to relax so that clean diagnostic EMG tests could be recorded, they were unable to envision EMG biofeedback treatment of motor disorders."
Whatmore and Kohli (1968) introduced the concept of dysponesis (misplaced effort) to explain how functional disorders (where body activity is disturbed) develop. Bracing your shoulders when you hear a loud sound illustrates dysponesis since this action does not protect against injury. These clinicians applied EMG biofeedback to diverse functional problems like headache and hypertension. They reported case follow-ups ranging from 6 to 21 years. This was long compared with typical 0-24 month follow-ups in the clinical literature. Their data showed that skill in controlling misplaced efforts was positively related to clinical improvement. Last, they wrote The Pathophysiology and Treatment of Functional Disorders (1974) that outlined their treatment of functional disorders.
Wolf (1983) integrated EMG biofeedback into physical therapy to treat stroke patients and conducted landmark stroke outcome studies.
Peper (1997) applied SEMG to the workplace, studied the ergonomics of computer use, and promoted "healthy computing."
Taub (1999, 2006) demonstrated the clinical efficacy of constraint-induced movement therapy
(CIMT) for the treatment of spinal cord-injured and stroke patients.
used yoga to produce atrial flutter at an average 306 beats per minute before a Menninger Foundation
audience. This briefly stopped his heart's pumping of blood and silenced his pulse.
Engel and Chism (1967) operantly trained subjects to decrease, increase, and then decrease their heart rates (this was analogous to ON-OFF-ON EEG training). He then used this approach to teach patients to control their rate of premature ventricular contractions (PVCs), where the ventricles contract too soon. Engel conceptualized this training protocol as illness onset training, since patients were taught to produce and then suppress a symptom. Peper has similarly taught asthmatics to wheeze to better control their breathing.
Schwartz (1971, 1972) examined whether specific patterns of cardiovascular activity are easier to learn than others due to biological constraints. He examined the constraints on learning integrated (two autonomic responses change in the same direction) and differentiated (two autonomic responses change inversely) patterns of blood pressure
and heart rate
change.
Schultz and Luthe (1969) developed Autogenic Training
, which is a deep relaxation exercise derived from hypnosis. This procedure combines passive volition with imagery in a series of three treatment procedures (standard Autogenic exercises, Autogenic neutralization, and Autogenic meditation). Clinicians at the Menninger Foundation
coupled an abbreviated list of standard exercises with thermal biofeedback to create autogenic biofeedback. Luthe (1973) also published a series of six volumes titled Autogenic therapy.
Fahrion and colleagues (1986) reported on an 18-26 session treatment program for hypertensive patients. The Menninger
program combined breathing modification, autogenic biofeedback for the hands and feet, and frontal EMG training. The authors reported that 89% of their medication patients discontinued or reduced medication by one-half while significantly lowering blood pressure. While this study did not include a double-blind control, the outcome rate was impressive.
Freedman and colleagues (1991) demonstrated that hand-warming and hand-cooling are produced by different mechanisms. The primary hand-warming mechanism is beta-adrenergic (hormonal), while the main hand-cooling mechanism is alpha-adrenergic and involves sympathetic C-fibers. This contradicts the traditional view that finger blood flow is exclusively controlled by sympathetic C-fibers. The traditional model asserts that when firing is slow, hands warm; when firing is rapid, hands cool. Freedman and colleagues’ studies support the view that hand-warming and hand-cooling represent entirely different skills.
Vaschillo and colleagues (1983) published the first studies of HRV biofeedback with cosmonauts and treated patients diagnosed with psychiatric and psychophysiological disorders. Lehrer collaborated with Smetankin and Potapova in treating pediatric asthma
patients and published influential articles on HRV asthma treatment in the medical journal Chest.
muscle (forehead) contraction. They demonstrated in 1973 that analog (proportional) and binary (ON or OFF) visual EMG biofeedback were equally helpful in lowering masseter SEMG levels.
Budzynski, Stoyva, Adler, and Mullaney (1973) reported that auditory frontalis EMG biofeedback combined with home relaxation practice lowered tension headache frequency and frontalis EMG levels. A control group that received noncontingent (false) auditory feedback did not improve. This study helped make the frontalis muscle the placement-of-choice in EMG assessment and treatment of headache and other psychophysiological disorders.
Sargent, Green, and Walters (1972, 1973) demonstrated that hand-warming could abort migraines and that autogenic biofeedback training could reduce headache activity. The early Menninger migraine studies, although methodologically weak (no pretreatment baselines, control groups, or random assignment to conditions), strongly influenced migraine treatment.
Flor (2002) trained amputees to detect the location and frequency of shocks delivered to their stumps, which resulted in an expansion of corresponding cortical regions and significant reduction of their phantom limb pain.
McNulty, Gevirtz, Hubbard, and Berkoff (1994) proposed that sympathetic nervous system
innervation of muscle spindles underlies trigger points.
The Association for Applied Psychophysiology and Biofeedback
(AAPB) and the International Society for Neurofeedback and Research (ISNR) have collaborated in validating and rating treatment protocols to address questions about the clinical efficacy of biofeedback and neurofeedback applications, like ADHD and headache. In 2001, Donald Moss, then president of the Association for Applied Psychophysiology and Biofeedback, and Jay Gunkelman, president of the International Society for Neurofeedback and Research, appointed a task force to establish standards for the efficacy of biofeedback and neurofeedback.
The Task Force document was published in 2002, and a series of white papers followed, reviewing the efficacy of a series of disorders. The white papers established the efficacy of biofeedback for functional anorectal disorders, attention deficit disorder, facial pain and temporomandibular disorder, hypertension
, urinary incontinence
, Raynaud's phenomenon
, substance abuse
, and headache
.
A broader review was published and later updated, applying the same efficacy standards to the entire range of medical and psychological disorders. The 2008 edition reviewed the efficacy of biofeedback for over 40 clinical disorders, ranging from alcoholism/substance abuse to vulvar vestibulitis
. The ratings for each disorder depend on the nature of research studies available on each disorder, ranging from anecdotal reports to double blind studies with a control group. Thus, a lower rating may reflect the lack of research rather than the ineffectiveness of biofeedback for the problem.
Level 1: Not empirically supported. This designation includes applications supported by anecdotal reports and/or case studies in non-peer reviewed venues. Yucha and Montgomery (2008) assigned eating disorders, immune function, spinal cord injury
, and syncope
to this category.
Level 2: Possibly efficacious. This designation requires at least one study of sufficient statistical power with well identified outcome measures but lacking randomized assignment to a control condition internal to the study. Yucha and Montgomery (2008) assigned asthma
, autism
, Bell palsy, cerebral palsy
, COPD, coronary artery disease, cystic fibrosis
, depression, erectile dysfunction
, fibromyalgia
, hand dystonia, irritable bowel syndrome
, PTSD, repetitive strain injury
, respiratory failure
, stroke
, tinnitus
, and urinary incontinence
in children to this category.
Level 3: Probably efficacious. This designation requires multiple observational studies, clinical studies, wait list controlled studies, and within subject and intrasubject replication studies that demonstrate efficacy. Yucha and Montgomery (2008) assigned alcoholism
and substance abuse
, arthritis
, diabetes mellitus
, fecal disorders in children, fecal incontinence
in adults, insomnia
, pediatric headache, traumatic brain injury
, urinary incontinence
in males, and vulvar vestibulitis
(vulvodynia
) to this category.
Level 4: Efficacious. This designation requires the satisfaction of six criteria:
(a) In a comparison with a no-treatment control group, alternative treatment group, or sham (placebo) control using randomized assignment, the investigational treatment is shown to be statistically significantly superior to the control condition or the investigational treatment is equivalent to a treatment of established efficacy in a study with sufficient power to detect moderate differences.
(b) The studies have been conducted with a population treated for a specific problem, for whom inclusion criteria are delineated in a reliable, operationally defined manner.
(c) The study used valid and clearly specified outcome measures related to the problem being treated.
(d) The data are subjected to appropriate data analysis.
(e) The diagnostic and treatment variables and procedures are clearly defined in a manner that permits replication of the study by independent researchers.
(f) The superiority or equivalence of the investigational treatment has been shown in at least two independent research settings.
Yucha and Montgomery (2008) assigned anxiety
, chronic pain
, epilepsy
, constipation
(adult), headache
(adult), hypertension
, motion sickness
, Raynaud's disease, and temporomandibular disorder to this category.
Level 5: Efficacious and specific. The investigational treatment must be shown to be statistically superior to credible sham therapy, pill, or alternative bona fide treatment in at least two independent research settings. Yucha and Montgomery (2008) assigned urinary incontinence
(females) to this category.
), achieves comparable or superior efficacy, is more cost effective, and enjoys a better side effect profile.
(AAPB) is a non-profit scientific and professional society for biofeedback and neurofeedback. The International Society for Neurofeedback and Research (ISNR) is a non-profit scientific and professional society for neurofeedback. The Biofeedback Foundation of Europe (BFE) sponsors international education, training, and research activities in biofeedback and neurofeedback. The Northeast Regional Biofeedback Association (NRBS) sponsors theme centered educational conferences, political advocacy for biofeedback friendly legislation, and research activities in biofeedback and neurofeedback in the Northeast regions of the United States.
(formerly the Biofeedback Certification Institute of America) is a non-profit organization that is a member of the Institute for Credentialing Excellence
(ICE). BCIA offers biofeedback certification, neurofeedback (also called EEG biofeedback) certification, and pelvic muscle dysfunction biofeedback. BCIA certifies individuals who meet education and training standards in biofeedback and neurofeedback and progressively recertifies those who satisfy continuing education requirements. BCIA certification has been endorsed by the Mayo Clinic, the Association for Applied Psychophysiology and Biofeedback
(AAPB), the International Society for Neurofeedback and Research (ISNR), and the Washington State Legislature.
The BCIA didactic education requirement includes a 48-hour course from a regionally-accredited academic institution or a BCIA-approved training program that covers the complete General Biofeedback Blueprint of Knowledge and study of human anatomy and physiology. The General Biofeedback Blueprint of Knowledge areas include: I. Orientation to Biofeedback, II. Stress, Coping, and Illness, III. Psychophysiological Recording, IV. Surface Electromyographic (SEMG) Applications, V. Autonomic Nervous System (ANS) Applications, VI. Electroencephalographic (EEG) Applications, VII. Adjunctive Interventions, and VIII. Professional Conduct.
Applicants may demonstrate their knowledge of human anatomy and physiology by completing a course in human anatomy, human physiology, or human biology provided by a regionally-accredited academic institution or a BCIA-approved training program or by successfully completing an Anatomy and Physiology exam covering the organization of the human body and its systems.
Applicants must also document practical skills training that includes 20 contact hours supervised by a BCIA-approved mentor designed to them teach how to apply clinical biofeedback skills through self-regulation training, 50 patient/client sessions, and case conference presentations. Distance learning allows applicants to complete didactic course work over the internet. Distance mentoring trains candidates from their residence or office. They must recertify every 4 years, complete 55 hours of continuing education during each review period or complete the written exam, and attest that their license/credential (or their supervisor’s license/credential) has not been suspended, investigated, or revoked.
Currently, only licensed health care providers may apply for this certification. Applicants must also document practical skills training that includes a 4-hour practicum/personal training session and 12 contact hours spent with a BCIA-approved mentor designed to them teach how to apply clinical biofeedback skills through 30 patient/client sessions and case conference presentations. They must recertify every 3 years, complete 36 hours of continuing education or complete the written exam, and attest that their license/credential has not been suspended, investigated or revoked.
proposed in 1865 that the body strives to maintain a steady state in the internal environment (milieu intérieur
), introducing the concept of homeostasis
. In 1885, J.R. Tarchanoff showed that voluntary control of heart rate could be fairly direct (cortical-autonomic) and did not depend on "cheating" by altering breathing rate. In 1901, J. H. Bair studied voluntary control of the retrahens aurem muscle that wiggles the ear
, discovering that subjects learned this skill by inhibiting interfering muscles and demonstrating that skeletal muscles are self-regulated. Alexander Graham Bell
attempted to teach the deaf to speak through the use of two devices - the phonautograph
, created by Édouard-Léon Scott’s
, and a manometric flame
. The former translated sound vibrations into tracings on smoked glass to show their acoustic waveforms, while the latter allowed sound to be displayed as patterns of light. After World War II
, mathematician Norbert Wiener
developed cybernetic theory
, that proposed that systems are controlled by monitoring their results. The participants at the landmark 1969 conference at the Surfrider Inn in Santa Monica coined the term biofeedback from Weiner's feedback
. The conference resulted in the founding of the Bio-Feedback Research Society, which permitted normally isolated researchers to contact and collaborate with each other, as well as popularizing the term “biofeedback.” The work of B.F. Skinner led researchers to apply operant conditioning
to biofeedback, decide which responses could be voluntarily controlled and which could not. The effects of the perception of autonomic nervous system activity was initially explored by George Mandler
's group in 1958. In 1965, Maia Lisina combined classical and operant conditioning to train subjects to change blood vessel diameter, eliciting and displaying reflexive blood flow changes to teach subjects how to voluntarily control the temperature of their skin. In 1974, H.D. Kimmel trained subjects to sweat using the galvanic skin response
.
Hinduism:
Biofeedback systems have been known in India and some other countries for millenia. Ancient Hindu practices like Yoga and Pranayama (Breathing techniques)are essentially biofeedback methods. Many yogis and sadhus have been known to exercise control over their physiological processes. In addition to recent research on Yoga, Paul Brunton, the British writer who travelled extensively in India, has written about many cases he has witnessed.
1962 - D. Shearn used feedback instead of conditioned stimuli to change heart rate.
1962 - Publication of Muscles Alive by John Basmajian and Carlo De Luca
1968 - Annual Veteran's Administration research meeting in Denver that brought together several biofeedback researchers
1969 - Conference on Altered States of Consciousness in Council Grove, Kansas in April and first meeting of the Bio-Feedback Research Society (BRS) at the Surfrider Inn in Santa Monica in October
1972 - Review and analysis of early biofeedback studies by D. Shearn in the 'Handbook of Psychophysiology'.
1975 - American Association of Biofeedback Clinicians was founded
1976 - BRS was renamed the Biofeedback Society of America (BSA)
1977 - Publication of Beyond Biofeedback by Elmer and Alyce Green and Biofeedback: Methods and Procedures in Clinical Practice by George Fuller
1978 - Publication of Biofeedback: A Survey of the Literature by Francine Butler
1979 - Publication of Biofeedback: Principles and Practice for Clinicians by John Basmajian and Mind/Body Integration: Essential Readings in Biofeedback by Erik Peper, Sonia Ancoli, and Michele Quinn
1980 - Biofeedback Certification Institute of America (BCIA) offered the first national certification examination in biofeedback and publication of Biofeedback: Clinical Applications in Behavioral Medicine by David Olton and Aaron Noonberg
1984 - Publication of Principles and Practice of Stress Management by Woolfolk and Lehrer
1987 - Publication of Biofeedback: A Practitioner's Guide by Mark Schwartz
1989 - BSA was renamed the Association for Applied Psychophysiology and Biofeedback
1991 - BCIA offered first national certification examination in stress management
1994 - Brain Wave and EMG sections were established within AAPB
1995 - Society for the Study of Neuronal Regulation (SSNR) was founded
1996 - Biofeedback Foundation of Europe (BFE) was established
1999 - SSNR was renamed the Society for Neuronal Regulation (SNR)
2002 - SNR was renamed the International Society for Neuronal Regulation (iSNR)
2003 - Publication of The Neurofeedback Book by Thompson and Thompson
2004 - Publication of Evidence-Based Practice in Biofeedback and Neurofeedback by Carolyn Yucha and Christopher Gilbert
2006 - ISNR was renamed the International Society for Neurofeedback & Research (ISNR)
2008 - Biofeedback Neurofeedback Alliance was formed to pool the resources of the AAPB, BCIA, and ISNR on joint initiatives
2008 - Biofeedback Alliance and Nomenclature Task Force defined biofeedback
2009 - The International Society for Neurofeedback & Research defined neurofeedback
2010 - Biofeedback Certification Institute of America renamed Biofeedback Certification International Alliance (BCIA)
Physiology
Physiology is the science of the function of living systems. This includes how organisms, organ systems, organs, cells, and bio-molecules carry out the chemical or physical functions that exist in a living system. The highest honor awarded in physiology is the Nobel Prize in Physiology or...
functions using instruments that provide information on the activity of those same systems, with a goal of being able to manipulate them at will. Processes that can be controlled include brainwaves
Electroencephalography
Electroencephalography is the recording of electrical activity along the scalp. EEG measures voltage fluctuations resulting from ionic current flows within the neurons of the brain...
, muscle tone
Muscle tone
In physiology, medicine, and anatomy, muscle tone is the continuous and passive partial contraction of the muscles, or the muscle’s resistance to passive stretch during resting state. It helps maintain posture, and it declines during REM sleep.-Purpose:Unconscious nerve impulses maintain the...
, skin conductance, heart rate
Heart rate
Heart rate is the number of heartbeats per unit of time, typically expressed as beats per minute . Heart rate can vary as the body's need to absorb oxygen and excrete carbon dioxide changes, such as during exercise or sleep....
and pain
Pain
Pain is an unpleasant sensation often caused by intense or damaging stimuli such as stubbing a toe, burning a finger, putting iodine on a cut, and bumping the "funny bone."...
perception.
Biofeedback may be used to improve health or performance, and the physiological changes often occur in conjunction with changes to thoughts, emotions, and behavior. Eventually, these changes can be maintained without the use of extra equipment.
Biofeedback has been found to be effective for the treatment of headache
Headache
A headache or cephalalgia is pain anywhere in the region of the head or neck. It can be a symptom of a number of different conditions of the head and neck. The brain tissue itself is not sensitive to pain because it lacks pain receptors. Rather, the pain is caused by disturbance of the...
s and migraine
Migraine
Migraine is a chronic neurological disorder characterized by moderate to severe headaches, and nausea...
s.
Definition
Three professional biofeedback organizations, the Association for Applied Psychophysiology and BiofeedbackAssociation for Applied Psychophysiology and Biofeedback
The Association for Applied Psychophysiology and Biofeedback was founded in 1969 as the Biofeedback Research Society . The association aims to promote a new understanding of biofeedback and advance the methods used in this practice...
(AAPB), Biofeedback Certification Institution of America (BCIA), and the International Society for Neurofeedback and Research (ISNR), arrived at a consensus definition of biofeedback in 2008:
Sensor modalities
Electromyograph
An electromyograph (EMGElectromyography
Electromyography is a technique for evaluating and recording the electrical activity produced by skeletal muscles. EMG is performed using an instrument called an electromyograph, to produce a record called an electromyogram. An electromyograph detects the electrical potential generated by muscle...
) 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
Anxiety
Anxiety is a psychological and physiological state characterized by somatic, emotional, cognitive, and behavioral components. The root meaning of the word anxiety is 'to vex or trouble'; in either presence or absence of psychological stress, anxiety can create feelings of fear, worry, uneasiness,...
and worry
Worry
Worry is thoughts, images and emotions of a negative nature in whichmental attempts are made to avoid anticipated potential threats. As an emotion it is experienced as anxiety or concern about a real or imagined issue, usually personal issues such as health or finances or broader ones such as...
, chronic pain
Chronic pain
Chronic pain has several different meanings in medicine. Traditionally, the distinction between acute and chronic pain has relied upon an arbitrary interval of time from onset; the two most commonly used markers being 3 months and 6 months since the initiation of pain, though some theorists and...
, computer-related disorder, essential hypertension
Essential hypertension
Essential hypertension is the form of hypertension that by definition, has no identifiable cause. It is the most common type of hypertension, affecting 95% of hypertensive patients, it tends to be familial and is likely to be the consequence of an interaction between environmental and genetic...
, headache
Headache
A headache or cephalalgia is pain anywhere in the region of the head or neck. It can be a symptom of a number of different conditions of the head and neck. The brain tissue itself is not sensitive to pain because it lacks pain receptors. Rather, the pain is caused by disturbance of the...
(migraine
Migraine
Migraine is a chronic neurological disorder characterized by moderate to severe headaches, and nausea...
, mixed headache, and tension-type headache), low back pain
Low back pain
Low back pain or lumbago is a common musculoskeletal disorder affecting 80% of people at some point in their lives. In the United States it is the most common cause of job-related disability, a leading contributor to missed work, and the second most common neurological ailment — only headache is...
, physical rehabilitation (cerebral palsy
Cerebral palsy
Cerebral palsy is an umbrella term encompassing a group of non-progressive, non-contagious motor conditions that cause physical disability in human development, chiefly in the various areas of body movement....
, incomplete spinal cord lesions, and stroke
Stroke
A stroke, previously known medically as a cerebrovascular accident , is the rapidly developing loss of brain function due to disturbance in the blood supply to the brain. This can be due to ischemia caused by blockage , or a hemorrhage...
), temporomandibular joint disorder
Temporomandibular joint disorder
Temporomandibular joint disorder , or TMJ syndrome, is an umbrella term covering acute or chronic inflammation of the temporomandibular joint, which connects the mandible to the skull. The disorder and resultant dysfunction can result in significant pain and impairment...
(TMD), torticollis
Torticollis
Torticollis, or wryneck, is a stiff neck associated with muscle spasm, classically causing lateral flexion contracture of the cervical spine musculature...
, and fecal incontinence
Fecal incontinence
Fecal incontinence is the loss of regular control of the bowels. Involuntary excretion and leaking are common occurrences for those affected. Subjects relating to defecation are often socially unacceptable, thus those affected may be beset by feelings of shame and humiliation...
, urinary incontinence
Urinary incontinence
Urinary incontinence is any involuntary leakage of urine. It is a common and distressing problem, which may have a profound impact on quality of life. Urinary incontinence almost always results from an underlying treatable medical condition but is under-reported to medical practitioners...
, and pelvic pain
Pelvic pain
Pelvic pain is a symptom that can affect both women and men. The pelvic pain that persists for a period of 3 months or more to be considered chronic while less than this duration is considered acute. The pain may indicate the existence of poorly-understood conditions that likely represent abnormal...
.
Feedback thermometer
A feedback thermometer detects skin temperature with a thermistorThermistor
A thermistor is a type of resistor whose resistance varies significantly with temperature, more so than in standard resistors. The word is a portmanteau of thermal and resistor...
(a temperature-sensitive resistor) that is usually attached to a finger or toe and measured in degrees Celsius or Fahrenheit. Skin temperature mainly reflects arteriole
Arteriole
An arteriole is a small diameter blood vessel in the microcirculation that extends and branches out from an artery and leads to capillaries.Arterioles have muscular walls and are the primary site of vascular resistance...
diameter. Hand-warming and hand-cooling are produced by separate mechanisms, and their regulation involves different skills. Hand-warming involves arteriole vasodilation
Vasodilation
Vasodilation refers to the widening of blood vessels resulting from relaxation of smooth muscle cells within the vessel walls, particularly in the large arteries, smaller arterioles and large veins. The process is essentially the opposite of vasoconstriction, or the narrowing of blood vessels. When...
produced by a beta-2 adrenegeric hormonal mechanism. Hand-cooling involves arteriole vasoconstriction
Vasoconstriction
Vasoconstriction is the narrowing of the blood vessels resulting from contraction of the muscular wall of the vessels, particularly the large arteries, small arterioles and veins. The process is the opposite of vasodilation, the widening of blood vessels. The process is particularly important in...
produced by the increased firing of sympathetic
Sympathetic nervous system
The sympathetic nervous system is one of the three parts of the autonomic nervous system, along with the enteric and parasympathetic systems. Its general action is to mobilize the body's nervous system fight-or-flight response...
C-fibers.
Biofeedback therapists use temperature biofeedback when treating chronic pain
Chronic pain
Chronic pain has several different meanings in medicine. Traditionally, the distinction between acute and chronic pain has relied upon an arbitrary interval of time from onset; the two most commonly used markers being 3 months and 6 months since the initiation of pain, though some theorists and...
, edema
Edema
Edema or oedema ; both words from the Greek , oídēma "swelling"), formerly known as dropsy or hydropsy, is an abnormal accumulation of fluid beneath the skin or in one or more cavities of the body that produces swelling...
, headache
Headache
A headache or cephalalgia is pain anywhere in the region of the head or neck. It can be a symptom of a number of different conditions of the head and neck. The brain tissue itself is not sensitive to pain because it lacks pain receptors. Rather, the pain is caused by disturbance of the...
(migraine
Migraine
Migraine is a chronic neurological disorder characterized by moderate to severe headaches, and nausea...
and tension-type headache), essential hypertension
Essential hypertension
Essential hypertension is the form of hypertension that by definition, has no identifiable cause. It is the most common type of hypertension, affecting 95% of hypertensive patients, it tends to be familial and is likely to be the consequence of an interaction between environmental and genetic...
, Raynaud’s disease
Raynaud's phenomenon
In medicine, Raynaud's phenomenon is a vasospastic disorder causing discoloration of the fingers, toes, and occasionally other areas. This condition can also cause nails to become brittle with longitudinal ridges. Named for French physician Maurice Raynaud , the phenomenon is believed to be the...
, anxiety
Anxiety
Anxiety is a psychological and physiological state characterized by somatic, emotional, cognitive, and behavioral components. The root meaning of the word anxiety is 'to vex or trouble'; in either presence or absence of psychological stress, anxiety can create feelings of fear, worry, uneasiness,...
, and stress
Stress (biology)
Stress is a term in psychology and biology, borrowed from physics and engineering and first used in the biological context in the 1930s, which has in more recent decades become commonly used in popular parlance...
.
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.In skin conductance, an electrodermograph imposes an imperceptible current across the skin and measures how easily it travels through the skin. When anxiety raises the level of sweat in a sweat duct, conductance increases. Skin conductance is measured in microsiemens (millionths of a siemens
Siemens (unit)
The siemens is the SI derived unit of electric conductance and electric admittance. Conductance and admittance are the reciprocals of resistance and impedance respectively, hence one siemens is equal to the reciprocal of one ohm, and is sometimes referred to as the mho. In English, the term...
). In skin potential, a therapist places an active electrode over an active site (e.g., the palmar surface of the hand) and a reference electrode over a relatively inactive site (e.g., forearm). Skin potential is the voltage that develops between eccrine sweat glands and internal tissues and is measured in millivolts (thousandths of a volt). In skin resistance, also called galvanic skin response
Galvanic skin response
Skin conductance, also known as galvanic skin response , electrodermal response , psychogalvanic reflex , skin conductance response or skin conductance level , is a method of measuring the electrical conductance of the skin, which varies with its moisture level...
(GSR), an electrodermograph imposes a current across the skin and measures the amount of opposition it encounters. Skin resistance is measured in kΩ (thousands of ohms).
Biofeedback therapists use electrodermal biofeedback when treating anxiety disorders, hyperhidrosis
Hyperhidrosis
Hyperhidrosis is the condition characterized by abnormally increased perspiration, in excess of that required for regulation of body temperature.-Classification:Hyperhidrosis can either be generalized or localized to specific parts of the body...
(excessive sweating), and stress
Stress (biology)
Stress is a term in psychology and biology, borrowed from physics and engineering and first used in the biological context in the 1930s, which has in more recent decades become commonly used in popular parlance...
. Electrodermal biofeedback is used as an adjunct to psychotherapy to increase client awareness of their emotions. In addition, electrodermal measures have long served as one of the central tools in polygraphy (lie detection) because they reflect changes in anxiety or emotional activation.
Electroencephalograph
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).The EEG uses precious metal electrodes to detect a voltage between at least two electrodes located on the scalp. The EEG records both excitatory postsynaptic potentials (EPSPs) and inhibitory postsynaptic potentials (IPSPs) that largely occur in dendrites in pyramidal cells located in macrocolumns, several millimeters in diameter, in the upper cortical layers. Neurofeedback
Neurofeedback
Neurofeedback , also called neurotherapy, neurobiofeedback or EEG biofeedback is a type of biofeedback that uses realtime displays of electroencephalography or functional magnetic resonance imaging to illustrate brain activity, often with a goal of controlling central nervous system activity...
monitors both slow and fast cortical potentials.
Slow cortical potentials are gradual changes in the membrane potentials of cortical dendrites that last from 300 ms to several seconds. These potentials include the contingent negative variation
Contingent negative variation
The contingent negative variation was one of the first event-related potential components to be described. The CNV component was first described by Dr. W. Grey Walter and colleagues in an article published in Nature in 1964...
(CNV), readiness potential, movement-related potentials (MRPs), and P300
P300 (neuroscience)
The P300 wave is an event related potential elicited by infrequent, task-relevant stimuli. It is considered to be an endogenous potential as its occurrence links not to the physical attributes of a stimulus but to a person's reaction to the stimulus. More specifically, the P300 is thought to...
and N400 potentials.
Fast cortical potentials range from 0.5 Hz to 100 Hz. The main frequency ranges include delta, theta, alpha, the sensorimotor rhythm, low beta, high beta, and gamma. The specific cutting points defining the frequency ranges vary considerably among professionals. Fast cortical potentials can be described by their predominant frequencies, but also by whether they are synchronous or asynchronous wave forms. Synchronous wave forms occur at regular periodic intervals, whereas asynchronous wave forms are irregular.
The synchronous delta rhythm ranges from 0.5 to 3.5 Hz. Delta is the dominant frequency from ages 1 to 2, and is associated in adults with deep sleep and brain pathology like trauma and tumors, and learning disability.
The synchronous theta rhythm
Theta rhythm
A theta rhythm is an oscillatory pattern in EEG signals recorded either from inside the brain or from electrodes glued to the scalp. Two types of theta rhythm have been described...
ranges from 4 to 7 Hz. Theta is the dominant frequency in healthy young children and is associated with drowsiness or starting to sleep, REM sleep, hypnagogic imagery (intense imagery experienced before the onset of sleep), hypnosis, attention, and processing of cognitive and perceptual information.
The synchronous alpha rhythm ranges from 8 to 13 Hz and is defined by its waveform and not by its frequency. Alpha activity can be observed in about 75% of awake, relaxed individuals and is replaced by low-amplitude desynchronized beta activity during movement, complex problem-solving, and visual focusing. This phenomenon is called alpha blocking.
The synchronous sensorimotor rhythm
Sensorimotor rhythm
- Description :The Sensory Motor Rhythm is brain wave rhythm. It is an oscillatory idle rhythm of synchronized electromagnetic brain activity. It appears in spindles in recordings of EEG, MEG, and ECoG over the sensorimotor cortex. For most individuals, the frequency of the SMR is in the range...
(SMR) ranges from 12 to 15 Hz and is located over the sensorimotor cortex (central sulcus). The sensorimotor rhythm is associated with the inhibition of movement and reduced muscle tone.
The beta rhythm consists of asynchronous waves and can be divided into low beta and high beta ranges (13–21 Hz and 20–32 Hz). Low beta is associated with activation and focused thinking. High beta is associated with anxiety
Anxiety
Anxiety is a psychological and physiological state characterized by somatic, emotional, cognitive, and behavioral components. The root meaning of the word anxiety is 'to vex or trouble'; in either presence or absence of psychological stress, anxiety can create feelings of fear, worry, uneasiness,...
, hypervigilance
Hypervigilance
Hypervigilance is an enhanced state of sensory sensitivity accompanied by an exaggerated intensity of behaviors whose purpose is to detect threats. Hypervigilance is also accompanied by a state of increased anxiety which can cause exhaustion. Other symptoms include: abnormally increased arousal, a...
, panic
Panic
Panic is a sudden sensation of fear which is so strong as to dominate or prevent reason and logical thinking, replacing it with overwhelming feelings of anxiety and frantic agitation consistent with an animalistic fight-or-flight reaction...
, peak performance, and worry
Worry
Worry is thoughts, images and emotions of a negative nature in whichmental attempts are made to avoid anticipated potential threats. As an emotion it is experienced as anxiety or concern about a real or imagined issue, usually personal issues such as health or finances or broader ones such as...
.
EEG activity from 36 to 44 Hz is also referred to as gamma. Gamma activity is associated with perception of meaning and meditative awareness.
Neurotherapists use EEG biofeedback when treating addiction
Substance use disorder
Substance use disorders include substance abuse and substance dependence. In DSM-IV, the conditions are formally diagnosed as one or the other, but it has been proposed that DSM-5 combine the two into a single condition called "Substance-use disorder"....
, attention deficit hyperactivity disorder (ADHD), learning disability
Learning disability
Learning disability is a classification including several disorders in which a person has difficulty learning in a typical manner, usually caused by an unknown factor or factors...
, anxiety disorders (including worry
Worry
Worry is thoughts, images and emotions of a negative nature in whichmental attempts are made to avoid anticipated potential threats. As an emotion it is experienced as anxiety or concern about a real or imagined issue, usually personal issues such as health or finances or broader ones such as...
, obsessive-compulsive disorder
Obsessive-compulsive disorder
Obsessive–compulsive disorder is an anxiety disorder characterized by intrusive thoughts that produce uneasiness, apprehension, fear, or worry, by repetitive behaviors aimed at reducing the associated anxiety, or by a combination of such obsessions and compulsions...
and posttraumatic stress disorder), depression, migraine
Migraine
Migraine is a chronic neurological disorder characterized by moderate to severe headaches, and nausea...
, and generalized seizures.
Photoplethysmograph
A photoplethysmographPhotoplethysmograph
A photoplethysmogram is an optically obtained plethysmogram, a volumetric measurement of an organ. A PPG is often obtained by using a pulse oximeter which illuminates the skin and measures changes in light absorption...
(PPG) measures the relative blood flow through a digit using a photoplethysmographic (PPG) sensor attached by a Velcro band to the fingers or to the temple to monitor the temporal artery. An infrared light source is transmitted through or reflected off the tissue, detected by a phototransistor, and quantified in arbitrary units. Less light is absorbed when blood flow is greater, increasing the intensity of light reaching the sensor.
A photoplethysmograph can measure blood volume pulse (BVP), which is the phasic change in blood volume with each heartbeat, heart rate
Heart rate
Heart rate is the number of heartbeats per unit of time, typically expressed as beats per minute . Heart rate can vary as the body's need to absorb oxygen and excrete carbon dioxide changes, such as during exercise or sleep....
, and heart rate variability
Heart rate variability
Heart rate variability is a physiological phenomenon where the time interval between heart beats varies. It is measured by the variation in the beat-to-beat interval....
(HRV), which consists of beat-to-beat differences in intervals between successive heartbeats.
A photoplethysmograph can provide useful feedback when temperature feedback shows minimal change. This is because the PPG sensor is more sensitive than a thermistor to minute blood flow changes. Biofeedback therapists can use a photoplethysmograph to supplement temperature biofeedback when treating chronic pain
Chronic pain
Chronic pain has several different meanings in medicine. Traditionally, the distinction between acute and chronic pain has relied upon an arbitrary interval of time from onset; the two most commonly used markers being 3 months and 6 months since the initiation of pain, though some theorists and...
, edema
Edema
Edema or oedema ; both words from the Greek , oídēma "swelling"), formerly known as dropsy or hydropsy, is an abnormal accumulation of fluid beneath the skin or in one or more cavities of the body that produces swelling...
, headache
Headache
A headache or cephalalgia is pain anywhere in the region of the head or neck. It can be a symptom of a number of different conditions of the head and neck. The brain tissue itself is not sensitive to pain because it lacks pain receptors. Rather, the pain is caused by disturbance of the...
(migraine
Migraine
Migraine is a chronic neurological disorder characterized by moderate to severe headaches, and nausea...
and tension-type headache), essential hypertension
Essential hypertension
Essential hypertension is the form of hypertension that by definition, has no identifiable cause. It is the most common type of hypertension, affecting 95% of hypertensive patients, it tends to be familial and is likely to be the consequence of an interaction between environmental and genetic...
, Raynaud’s disease, anxiety
Anxiety
Anxiety is a psychological and physiological state characterized by somatic, emotional, cognitive, and behavioral components. The root meaning of the word anxiety is 'to vex or trouble'; in either presence or absence of psychological stress, anxiety can create feelings of fear, worry, uneasiness,...
, and stress
Stress (biology)
Stress is a term in psychology and biology, borrowed from physics and engineering and first used in the biological context in the 1930s, which has in more recent decades become commonly used in popular parlance...
.
Electrocardiograph
The electrocardiograph (ECG) uses electrodes placed on the torso, wrists, or legs, to measure the electrical activity of the heart and measures the interbeat intervalInterbeat interval
Interbeat interval is a scientific term used in the study of the mammalian heart.- Definition :Interbeat interval is a scientific term used in reference to the time interval between individual beats of the mammalian heart...
(distances between successive R-wave peaks in the QRS complex
QRS complex
The QRS complex is a name for the combination of three of the graphical deflections seen on a typical electrocardiogram . It is usually the central and most visually obvious part of the tracing. It corresponds to the depolarization of the right and left ventricles of the human heart...
). The interbeat interval, divided into 60 seconds, determines the heart rate at that moment. The statistical variability of that interbeat interval is what we call heart rate variability
Heart rate variability
Heart rate variability is a physiological phenomenon where the time interval between heart beats varies. It is measured by the variation in the beat-to-beat interval....
. The ECG method is more accurate than the PPG method in measuring heart rate variability.
Biofeedback therapists use HRV biofeedback when treating asthma
Asthma
Asthma is the common chronic inflammatory disease of the airways characterized by variable and recurring symptoms, reversible airflow obstruction, and bronchospasm. Symptoms include wheezing, coughing, chest tightness, and shortness of breath...
, COPD, depression, fibromyalgia
Fibromyalgia
Fibromyalgia is a medical disorder characterized by chronic widespread pain and allodynia, a heightened and painful response to pressure. It is an example of a diagnosis of exclusion...
, heart disease
Heart disease
Heart disease, cardiac disease or cardiopathy is an umbrella term for a variety of diseases affecting the heart. , it is the leading cause of death in the United States, England, Canada and Wales, accounting for 25.4% of the total deaths in the United States.-Types:-Coronary heart disease:Coronary...
, and unexplained abdominal pain
Abdominal pain
Abdominal pain can be one of the symptoms associated with transient disorders or serious disease. Making a definitive diagnosis of the cause of abdominal pain can be difficult, because many diseases can result in this symptom. Abdominal pain is a common problem...
.
Pneumograph
A pneumographPneumograph
A pneumograph, also known as a pneumatograph or spirograph, is a device for recording velocity and force of chest movements during respiration.-Principle of operation:...
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
Respiration rate
The respiration rate is a parameter which is used in ecological and agronomical modeling.In theoretical production ecology and aquaculture, it typically refers to respiration per unit of time , also referred to as relative respiration rate...
(the number of breaths per minute). Clinicians can use a pneumograph to detect and correct dysfunctional breathing patterns and behaviors. Dysfunctional breathing patterns include clavicular breathing (breathing that primarily relies on the external intercostals and the accessory muscles of respiration to inflate the lungs), reverse breathing
Reverse breathing
Reverse Breathing is a breathing technique associated with yoga and qigong. It consists of expanding the abdomen while breathing out through the nose, and then compressing it while inhaling via the mouth -- the opposite of what an abdomen would do during natural, instinctive breathing. Via this...
(breathing where the abdomen expands during exhalation and contracts during inhalation), and thoracic breathing (shallow breathing that primarily relies on the external intercostals to inflate the lungs). Dysfunctional breathing behaviors include apnea
Apnea
Apnea, apnoea, or apnœa is a term for suspension of external breathing. During apnea there is no movement of the muscles of respiration and the volume of the lungs initially remains unchanged...
(suspension of breathing), gasping, sighing, and wheezing.
A pneumograph is often used in conjunction with an electrocardiograph (ECG) or photoplethysmograph
Photoplethysmograph
A photoplethysmogram is an optically obtained plethysmogram, a volumetric measurement of an organ. A PPG is often obtained by using a pulse oximeter which illuminates the skin and measures changes in light absorption...
(PPG) in heart rate variability
Heart rate variability
Heart rate variability is a physiological phenomenon where the time interval between heart beats varies. It is measured by the variation in the beat-to-beat interval....
(HRV) training.
Biofeedback therapists use pneumograph biofeedback with patients diagnosed with anxiety disorders, asthma
Asthma
Asthma is the common chronic inflammatory disease of the airways characterized by variable and recurring symptoms, reversible airflow obstruction, and bronchospasm. Symptoms include wheezing, coughing, chest tightness, and shortness of breath...
, chronic pulmonary obstructive disorder (COPD), essential hypertension
Essential hypertension
Essential hypertension is the form of hypertension that by definition, has no identifiable cause. It is the most common type of hypertension, affecting 95% of hypertensive patients, it tends to be familial and is likely to be the consequence of an interaction between environmental and genetic...
, panic attacks, and stress
Stress (biology)
Stress is a term in psychology and biology, borrowed from physics and engineering and first used in the biological context in the 1930s, which has in more recent decades become commonly used in popular parlance...
.
Capnometer
A capnometer or capnographCapnograph
A capnograph is an instrument used to measure the carbon dioxide concentration in an air sample. It does this by measuring the absorption of infrared light, which is absorbed particularly well by carbon dioxide....
uses an infrared detector to measure end-tidal (the partial pressure of carbon dioxide in expired air at the end of expiration) exhaled through the nostril into a latex tube. The average value of end-tidal for a resting adult is 5% (36 torr). A capnometer is a sensitive index of the quality of patient breathing. Shallow, rapid, and effortful breathing lowers , while deep, slow, effortless breathing increases it.
Biofeedback therapists use capnometric biofeedback to supplement respiratory strain gauge biofeedback with patients diagnosed with anxiety disorders, asthma
Asthma
Asthma is the common chronic inflammatory disease of the airways characterized by variable and recurring symptoms, reversible airflow obstruction, and bronchospasm. Symptoms include wheezing, coughing, chest tightness, and shortness of breath...
, chronic pulmonary obstructive disorder (COPD), essential hypertension
Essential hypertension
Essential hypertension is the form of hypertension that by definition, has no identifiable cause. It is the most common type of hypertension, affecting 95% of hypertensive patients, it tends to be familial and is likely to be the consequence of an interaction between environmental and genetic...
, panic attacks, and stress
Stress (biology)
Stress is a term in psychology and biology, borrowed from physics and engineering and first used in the biological context in the 1930s, which has in more recent decades become commonly used in popular parlance...
.
Rheoencephalograph
RheoencephalographyRheoencephalography
Rheoencephalography a technique of continuous registration of cerebral blood flow. An electronic device called a rheoencephalograph is used in rheoencephalography. Electrodes are attached to the cranium at specifc points on the head and allow the device to continuously measure the electrical...
(REG), or brain blood flow biofeedback, is a biofeedback technique of a conscious control of blood flow. An electronic device called a rheoencephalograph [from Greek rheos stream, anything flowing, from rhein to flow] is utilized in brain blood flow biofeedback. Electrodes are attached to the skin at certain points on the head and permit the device to measure continuously the electrical conductivity of the tissues of structures located between the electrodes. The brain blood flow technique is based on non-invasive method of measuring bio-impedance. Changes in bio-impedance are generated by blood volume and blood flow and registered by a rheographic device. The pulsative bio-impedance changes directly reflect the total blood flow of the deep structures of brain due to high frequency impedance measurements.
Hemoencephalography
HemoencephalographyHemoencephalography
Hemoencephalography is a relatively new neurofeedback technique within the field of neurotherapy. Neurofeedback, a specific form of biofeedback, is based on the idea that human beings can consciously alter their brain function through training sessions in which they attempt to change the signal...
or HEG biofeedback is a functional infrared
Infrared
Infrared light is electromagnetic radiation with a wavelength longer than that of visible light, measured from the nominal edge of visible red light at 0.74 micrometres , and extending conventionally to 300 µm...
imaging technique. As its name describes, it measures the differences in the color of light reflected back through the scalp based on the relative amount of oxygenated and unoxygenated blood in the brain. Research continues to determine its reliability, validity, and clinical applicability. HEG is used to treat ADHD and migraine
Migraine
Migraine is a chronic neurological disorder characterized by moderate to severe headaches, and nausea...
, and for research.
Incontinence
Mowrer detailed the use of a bedwetting alarm that sounds when children urinate while asleep. This simple biofeedback device can quickly teach children to wake up when their bladders are full and to contract the urinary sphincter and relax the detrusor muscle, preventing further urine release. Through classical conditioning, sensory feedback from a full bladder replaces the alarm and allows children to continue sleeping without urinating.Kegel
Arnold Kegel
Arnold H. Kegel M.D., F.A.C.S. was a gynecologist who invented the Kegel Perineometer and Kegel exercises as non-surgical treatment of genital relaxation...
developed the perineometer in 1947 to treat urinary incontinence (urine leakage) in women whose pelvic floor muscles are weakened during pregnancy and childbirth. The perineometer, which is inserted into the vagina to monitor pelvic floor muscle contraction, satisfies all the requirements of a biofeedback device and enhances the effectiveness of popular Kegel exercises.
Research has shown that biofeedback can improve the efficacy of pelvic floor exercises and help restore proper bladder functions. The mode of action of vaginal cones, for instance involves a biological biofeedback mechanism . Studies have shown that biofeedback obtained with vaginal cones is as effective as biofeedback induced through physiotherapy electrostimulation.
In 1992, the United States Agency for Health Care Policy and Research recommended biofeedback as a first-line treatment for adult urinary incontinence.
EEG
CatonRichard Caton
Richard Caton , of Liverpool, England, was a scientist who was crucial in discovering the electrical nature of the brain and laid the groundwork for Hans Berger to discover Alpha wave activity in the human brain....
recorded spontaneous electrical potentials from the exposed cortical surface of monkeys and rabbits, and was the first to measure event-related potentials (EEG responses to stimuli) in 1875.
Danilevsky published Investigations in the Physiology of the Brain, which explored the relationship between the EEG and states of consciousness in 1877.
Beck
Adolf Beck (physiologist)
Adolf Beck was a Polish Jew, physician of and professor of physiology at the University of Lemberg....
published studies of spontaneous electrical potentials detected from the brains of dogs and rabbits, and was the first to document alpha blocking, where light alters rhythmic oscillations, in 1890.
Sherrington
Charles Scott Sherrington
Sir Charles Scott Sherrington, OM, GBE, PRS was an English neurophysiologist, histologist, bacteriologist, and a pathologist, Nobel laureate and president of the Royal Society in the early 1920s...
introduced the terms neuron
Neuron
A neuron is an electrically excitable cell that processes and transmits information by electrical and chemical signaling. Chemical signaling occurs via synapses, specialized connections with other cells. Neurons connect to each other to form networks. Neurons are the core components of the nervous...
and synapse
Synapse
In the nervous system, a synapse is a structure that permits a neuron to pass an electrical or chemical signal to another cell...
and published the Integrative Action of the Nervous System in 1906.
Pravdich-Neminsky
Vladimir Pravdich-Neminsky
Vladimir Pravdich-Neminsky was a Ukrainian physiologist who published the first EEG and the evoked potential of the mammalian brain. He was a representative of the Kazan and Kiev Physiological Schools.-Works:* Pravdich-Neminsky VV. Ein Versuch der Registrierung der elektrischen Gehirnerscheinungen...
photographed the EEG and event related potentials from dogs, demonstrated a 12–14 Hz rhythm that slowed during asphyxiation, and introduced the term electrocerebrogram in 1912.
Forbes reported the replacement of the string galvanometer with a vacuum tube to amplify the EEG in 1920. The vacuum tube became the de facto standard by 1936.
Berger
Hans Berger
Hans Berger was born in Neuses near Coburg, Bavaria, Germany. He is best known as the first to record human electroencephalograms in 1924, for which he invented the electroencephalogram , and the discoverer of the alpha wave rhythm known as "Berger's wave".- Biography :After attending...
(1924) published the first human EEG data. He recorded electrical potentials from his son Klaus's scalp. At first he believed that he had discovered the physical mechanism for telepathy but was disappointed that the electromagnetic variations disappear only millimeters away from the skull. (He did continue to believe in telepathy throughout his life, however, having had a particularly confirming event regarding his sister). He viewed the EEG as analogous to the ECG and introduced the term elektenkephalogram. He believed that the EEG had diagnostic and therapeutic promise in measuring the impact of clinical interventions. Berger showed that these potentials were not due to scalp muscle contractions. He first identified the alpha rhythm, which he called the Berger rhythm, and later identified the beta rhythm and sleep spindles. He demonstrated that alterations in consciousness are associated with changes in the EEG and associated the beta rhythm with alertness. He described interictal activity (EEG potentials between seizures) and recorded a partial complex seizure in 1933. Finally, he performed the first QEEG, which is the measurement of the signal strength of EEG frequencies.
Adrian
Edgar Adrian, 1st Baron Adrian
Edgar Douglas Adrian, 1st Baron Adrian OM PRS was a British electrophysiologist and recipient of the 1932 Nobel Prize for Physiology, won jointly with Sir Charles Sherrington for work on the function of neurons....
and Matthews confirmed Berger's findings in 1934 by recording their own EEGs using a cathode-ray oscilloscope. Their demonstration of EEG recording at the 1935 Physiological Society meetings in England caused its widespread acceptance. Adrian used himself as a subject and demonstrated the phenomenon of alpha blocking, where opening his eyes suppressed alpha rhythms.
Gibbs
Frederic A. Gibbs
Frederic Andrews Gibbs was an American neurologist who was a pioneer in the use of electroencephalography for the diagnosis and treatment of epilepsy....
, Davis
Hallowell Davis
Hallowell Davis was an American physiologist and otolaryngologist and researcher who did pioneering work on the physiology of hearing and the inner ear. He served as director of research at the Central Institute for the Deaf in St...
, and Lennox inaugurated clinical electroencephalography in 1935 by identifying abnormal EEG rhythms associated with epilepsy, including interictal spike waves and 3 Hz activity in absence seizures.
Bremer used the EEG to show how sensory signals affect vigilance in 1935.
Walter
William Grey Walter
W. Grey Walter was a neurophysiologist and robotician.-Overview:Walter was born in Kansas City, Missouri, in 1910. His ancestry was German/British on his father's side, and American/British on his mother's side. He was brought to England in 1915, and educated at Westminster School and afterwards...
(1937, 1953) named the delta waves and theta waves, and the contingent negative variation
Contingent negative variation
The contingent negative variation was one of the first event-related potential components to be described. The CNV component was first described by Dr. W. Grey Walter and colleagues in an article published in Nature in 1964...
(CNV), a slow cortical potential that may reflect expectancy, motivation, intention to act, or attention. He located an occipital lobe
Occipital lobe
The occipital lobe is the visual processing center of the mammalian brain containing most of the anatomical region of the visual cortex. The primary visual cortex is Brodmann area 17, commonly called V1...
source for alpha waves and demonstrated that delta waves can help locate brain lesions like tumors. He improved Berger's electroencephalograph and pioneered EEG topography.
Kleitman has been recognized as the "Father of American sleep research" for his seminal work in the regulation of sleep-wake cycles, circadian rhythms, the sleep patterns of different age groups, and the effects of sleep deprivation
Sleep deprivation
Sleep deprivation is the condition of not having enough sleep; it can be either chronic or acute. A chronic sleep-restricted state can cause fatigue, daytime sleepiness, clumsiness and weight loss or weight gain. It adversely affects the brain and cognitive function. Few studies have compared the...
. He discovered the phenomenon of rapid eye movement (REM) sleep with his graduate student Aserinsky in 1953.
Dement, another of Kleitman's students, described the EEG architecture and phenomenology of sleep stages and the transitions between them in 1955, associated REM sleep with dreaming in 1957, and documented sleep cycles in another species, cats, in 1958, which stimulated basic sleep research. He established the Stanford University Sleep Research Center in 1970.
Andersen and Andersson (1968) proposed that thalamic pacemakers project synchronous alpha rhythms to the cortex
Cerebral cortex
The cerebral cortex is a sheet of neural tissue that is outermost to the cerebrum of the mammalian brain. It plays a key role in memory, attention, perceptual awareness, thought, language, and consciousness. It is constituted of up to six horizontal layers, each of which has a different...
via thalamocortical circuits.
Kamiya (1968) demonstrated that the alpha rhythm in humans could be operantly conditioned. He published an influential article in Psychology Today that summarized research that showed that subjects could learn to discriminate when alpha was present or absent, and that they could use feedback to shift the dominant alpha frequency about 1 Hz. Almost half of his subjects reported experiencing a pleasant "alpha state" characterized as an "alert calmness." These reports may have contributed to the perception of alpha biofeedback as a shortcut to a meditative state. He also studied the EEG correlates of meditative states.
Brown (1970) demonstrated the clinical use of alpha-theta biofeedback. In research designed to identify the subjective states associated with EEG rhythms, she trained subjects to increase the abundance of alpha, beta, and theta activity using visual feedback and recorded their subjective experiences when the amplitude of these frequency bands increased. She also helped popularize biofeedback by publishing a series of books, including New Mind, New body (1974) and Stress and the Art of Biofeedback (1977).
Mulholland and Peper (1971) showed that occipital alpha increases with eyes open and not focused, and is disrupted by visual focusing; a rediscovery of alpha blocking.
Green and Green (1986) investigated voluntary control of internal states by individuals like Swami Rama and American Indian medicine man Rolling Thunder both in India and at the Menninger Foundation
Menninger Foundation
The Menninger Foundation was founded in 1919 by the Menninger family in Topeka, Kansas, and consists of a clinic, a sanatorium, and a school of psychiatry, all of which bear the Menninger name. In 2003, the Menninger Clinic moved to Houston. The foundation was started by Drs. Karl, Will, and...
. They brought portable biofeedback equipment to India and monitored practitioners as they demonstrated self-regulation. A film containing footage from their investigations was released as Biofeedback: The Yoga of the West (1974). They developed alpha-theta training at the Menninger Foundation from the 1960s to the 1990s. They hypothesized that theta states allow access to unconscious memories and increase the impact of prepared images or suggestions. Their alpha-theta research fostered Peniston's development of an alpha-theta addiction protocol.
Sterman (1972) showed that cats and human subjects could be operantly trained to increase the amplitude of the sensorimotor rhythm
Sensorimotor rhythm
- Description :The Sensory Motor Rhythm is brain wave rhythm. It is an oscillatory idle rhythm of synchronized electromagnetic brain activity. It appears in spindles in recordings of EEG, MEG, and ECoG over the sensorimotor cortex. For most individuals, the frequency of the SMR is in the range...
(SMR) recorded from the sensorimotor cortex. He demonstrated that SMR production protects cats against drug-induced generalized seizures (tonic-clonic seizures involving loss of consciousness) and reduces the frequency of seizures in humans diagnosed with epilepsy
Epilepsy
Epilepsy is a common chronic neurological disorder characterized by seizures. These seizures are transient signs and/or symptoms of abnormal, excessive or hypersynchronous neuronal activity in the brain.About 50 million people worldwide have epilepsy, and nearly two out of every three new cases...
. He found that his SMR protocol, which uses visual and auditory EEG biofeedback, normalizes their EEGs (SMR increases while theta and beta decrease toward normal values) even during sleep. Sterman also co-developed the Sterman-Kaiser (SKIL) QEEG database.
Birbaumer and colleagues (1981) have studied feedback of slow cortical potentials since the late 1970s. They have demonstrated that subjects can learn to control these DC potentials and have studied the efficacy of slow cortical potential biofeedback in treating ADHD, epilepsy, migraine, and schizophrenia.
Lubar (1989) studied SMR biofeedback to treat attention disorders and epilepsy in collaboration with Sterman. He demonstrated that SMR training can improve attention and academic performance in children diagnosed with Attention Deficit Disorder with Hyperactivity (ADHD). He documented the importance of theta-to-beta ratios in ADHD and developed theta suppression-beta enhancement protocols to decrease these ratios and improve student performance.
Electrodermal system
Feré demonstrated the exosomatic method of recording of skin electrical activity by passing a small current through the skin in 1888.Tarchanoff used the endosomatic method by recording the difference in skin electrical potential from points on the skin surface in 1889; no external current was applied.
Jung
Jung
Carl Jung was a Swiss psychiatrist, an influential thinker and the founder of analytical psychology.Jung may also refer to:* Jung * JUNG, Java Universal Network/Graph Framework-See also:...
employed the galvanometer
Galvanometer
A galvanometer is a type of ammeter: an instrument for detecting and measuring electric current. It is an analog electromechanical transducer that produces a rotary deflection of some type of pointer in response to electric current flowing through its coil in a magnetic field. .Galvanometers were...
, which used the exosomatic method, in 1907 to study unconscious emotions in word-association experiments.
Marjorie and Hershel Toomim (1975) published a landmark article about the use of GSR biofeedback in psychotherapy.
Musculoskeletal system
JacobsonEdmund Jacobson
Edmund Jacobson was a US-American physician in internal medicine and psychiatry and a physiologist. He was the founder of the Progressive Muscle Relaxation and of Biofeedback....
(1930) developed hardware to measure EMG voltages over time, showed that cognitive activity (like imagery) affects EMG levels, introduced the deep relaxation method Progressive Relaxation, and wrote Progressive Relaxation (1929) and You Must Relax (1934). He prescribed daily Progressive Relaxation practice to treat diverse psychophysiological disorders like hypertension.
Several researchers showed that human subjects could learn precise control of individual motor units (motor neurons and the muscle fibers they control). Lindsley (1935) found that relaxed subjects could suppress motor unit firing without biofeedback training.
Harrison and Mortensen (1962) trained subjects using visual and auditory EMG biofeedback to control individual motor units in the tibialis anterior muscle of the leg.
Basmajian (1963) instructed subjects using unfiltered auditory EMG biofeedback to control separate motor units in the abductor pollicis muscle of the thumb in his Single Motor Unit Training (SMUT) studies. His best subjects coordinated several motor units to produce drum rolls. Basmajian demonstrated practical applications for neuromuscular rehabilitation, pain management
Pain management
Pain management is a branch of medicine employing an interdisciplinary approach for easing the suffering and improving the quality of life of those living with pain. The typical pain management team includes medical practitioners, clinical psychologists, physiotherapists, occupational therapists,...
, and headache treatment.
Marinacci (1960) applied EMG biofeedback to neuromuscular disorders (where proprioception
Proprioception
Proprioception , from Latin proprius, meaning "one's own" and perception, is the sense of the relative position of neighbouring parts of the body and strength of effort being employed in movement...
is disrupted) including Bell Palsy (one-sided facial paralysis), polio, and stroke
Stroke
A stroke, previously known medically as a cerebrovascular accident , is the rapidly developing loss of brain function due to disturbance in the blood supply to the brain. This can be due to ischemia caused by blockage , or a hemorrhage...
.
"While Marinacci used EMG to treat neuromuscular disorders, his colleagues only used the EMG for diagnosis. They were unable to recognize its potential as a teaching tool even when the evidence stared them in the face! Many electromyographers who performed nerve conduction studies used visual and auditory feedback to reduce interference when a patient recruited too many motor units. Even though they used EMG biofeedback to guide the patient to relax so that clean diagnostic EMG tests could be recorded, they were unable to envision EMG biofeedback treatment of motor disorders."
Whatmore and Kohli (1968) introduced the concept of dysponesis (misplaced effort) to explain how functional disorders (where body activity is disturbed) develop. Bracing your shoulders when you hear a loud sound illustrates dysponesis since this action does not protect against injury. These clinicians applied EMG biofeedback to diverse functional problems like headache and hypertension. They reported case follow-ups ranging from 6 to 21 years. This was long compared with typical 0-24 month follow-ups in the clinical literature. Their data showed that skill in controlling misplaced efforts was positively related to clinical improvement. Last, they wrote The Pathophysiology and Treatment of Functional Disorders (1974) that outlined their treatment of functional disorders.
Wolf (1983) integrated EMG biofeedback into physical therapy to treat stroke patients and conducted landmark stroke outcome studies.
Peper (1997) applied SEMG to the workplace, studied the ergonomics of computer use, and promoted "healthy computing."
Taub (1999, 2006) demonstrated the clinical efficacy of constraint-induced movement therapy
Constraint-induced movement therapy
Constraint-induced movement therapy is a form of rehabilitation therapy that improves upper extremity function in stroke and other Central Nervous System damage victims by increasing the use of their affected upper limb....
(CIMT) for the treatment of spinal cord-injured and stroke patients.
Cardiovascular system
Shearn (1962) operantly trained human subjects to increase their heart rates by 5 beats-per-minute to avoid electric shock. In contrast to Shearn's slight heart rate increases, Swami RamaSwami Rama
Swāmī Rāma was born Brij Kiśore Dhasmana or Brij Kiśore Kumar, to a northern Indian Brahmin family in a small village called Toli in the Garhwal Himalayas. He became the lineage holder of the Sankya Yoga tradition of the Himalayan Masters...
used yoga to produce atrial flutter at an average 306 beats per minute before a Menninger Foundation
Menninger Foundation
The Menninger Foundation was founded in 1919 by the Menninger family in Topeka, Kansas, and consists of a clinic, a sanatorium, and a school of psychiatry, all of which bear the Menninger name. In 2003, the Menninger Clinic moved to Houston. The foundation was started by Drs. Karl, Will, and...
audience. This briefly stopped his heart's pumping of blood and silenced his pulse.
Engel and Chism (1967) operantly trained subjects to decrease, increase, and then decrease their heart rates (this was analogous to ON-OFF-ON EEG training). He then used this approach to teach patients to control their rate of premature ventricular contractions (PVCs), where the ventricles contract too soon. Engel conceptualized this training protocol as illness onset training, since patients were taught to produce and then suppress a symptom. Peper has similarly taught asthmatics to wheeze to better control their breathing.
Schwartz (1971, 1972) examined whether specific patterns of cardiovascular activity are easier to learn than others due to biological constraints. He examined the constraints on learning integrated (two autonomic responses change in the same direction) and differentiated (two autonomic responses change inversely) patterns of blood pressure
Blood pressure
Blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels, and is one of the principal vital signs. When used without further specification, "blood pressure" usually refers to the arterial pressure of the systemic circulation. During each heartbeat, BP varies...
and heart rate
Heart rate
Heart rate is the number of heartbeats per unit of time, typically expressed as beats per minute . Heart rate can vary as the body's need to absorb oxygen and excrete carbon dioxide changes, such as during exercise or sleep....
change.
Schultz and Luthe (1969) developed Autogenic Training
Autogenic training
Autogenic training is a relaxation technique developed by the German psychiatrist Johannes Heinrich Schultz and first published in 1932. The technique involves the daily practice of sessions that last around 15 minutes, usually in the morning, at lunch time, and in the evening. During each session,...
, which is a deep relaxation exercise derived from hypnosis. This procedure combines passive volition with imagery in a series of three treatment procedures (standard Autogenic exercises, Autogenic neutralization, and Autogenic meditation). Clinicians at the Menninger Foundation
Menninger Foundation
The Menninger Foundation was founded in 1919 by the Menninger family in Topeka, Kansas, and consists of a clinic, a sanatorium, and a school of psychiatry, all of which bear the Menninger name. In 2003, the Menninger Clinic moved to Houston. The foundation was started by Drs. Karl, Will, and...
coupled an abbreviated list of standard exercises with thermal biofeedback to create autogenic biofeedback. Luthe (1973) also published a series of six volumes titled Autogenic therapy.
Fahrion and colleagues (1986) reported on an 18-26 session treatment program for hypertensive patients. The Menninger
program combined breathing modification, autogenic biofeedback for the hands and feet, and frontal EMG training. The authors reported that 89% of their medication patients discontinued or reduced medication by one-half while significantly lowering blood pressure. While this study did not include a double-blind control, the outcome rate was impressive.
Freedman and colleagues (1991) demonstrated that hand-warming and hand-cooling are produced by different mechanisms. The primary hand-warming mechanism is beta-adrenergic (hormonal), while the main hand-cooling mechanism is alpha-adrenergic and involves sympathetic C-fibers. This contradicts the traditional view that finger blood flow is exclusively controlled by sympathetic C-fibers. The traditional model asserts that when firing is slow, hands warm; when firing is rapid, hands cool. Freedman and colleagues’ studies support the view that hand-warming and hand-cooling represent entirely different skills.
Vaschillo and colleagues (1983) published the first studies of HRV biofeedback with cosmonauts and treated patients diagnosed with psychiatric and psychophysiological disorders. Lehrer collaborated with Smetankin and Potapova in treating pediatric asthma
Asthma
Asthma is the common chronic inflammatory disease of the airways characterized by variable and recurring symptoms, reversible airflow obstruction, and bronchospasm. Symptoms include wheezing, coughing, chest tightness, and shortness of breath...
patients and published influential articles on HRV asthma treatment in the medical journal Chest.
Pain
Budzynski and Stoyva (1969) showed that EMG biofeedback could reduce frontalisFrontalis muscle
The Frontalis muscle , also known as the occipitofrontalis or epicranius, is thin, of a quadrilateral form, and intimately adherent to the superficial fascia. It is broader than the Occipitalis and its fibers are longer and paler in color...
muscle (forehead) contraction. They demonstrated in 1973 that analog (proportional) and binary (ON or OFF) visual EMG biofeedback were equally helpful in lowering masseter SEMG levels.
Budzynski, Stoyva, Adler, and Mullaney (1973) reported that auditory frontalis EMG biofeedback combined with home relaxation practice lowered tension headache frequency and frontalis EMG levels. A control group that received noncontingent (false) auditory feedback did not improve. This study helped make the frontalis muscle the placement-of-choice in EMG assessment and treatment of headache and other psychophysiological disorders.
Sargent, Green, and Walters (1972, 1973) demonstrated that hand-warming could abort migraines and that autogenic biofeedback training could reduce headache activity. The early Menninger migraine studies, although methodologically weak (no pretreatment baselines, control groups, or random assignment to conditions), strongly influenced migraine treatment.
Flor (2002) trained amputees to detect the location and frequency of shocks delivered to their stumps, which resulted in an expansion of corresponding cortical regions and significant reduction of their phantom limb pain.
McNulty, Gevirtz, Hubbard, and Berkoff (1994) proposed that sympathetic nervous system
Sympathetic nervous system
The sympathetic nervous system is one of the three parts of the autonomic nervous system, along with the enteric and parasympathetic systems. Its general action is to mobilize the body's nervous system fight-or-flight response...
innervation of muscle spindles underlies trigger points.
Research
Moss, LeVaque, and Hammond (2004) observed that “Biofeedback and neurofeedback seem to offer the kind of evidence-based practice that the health care establishment is demanding." "From the beginning biofeedback developed as a research-based approach emerging directly from laboratory research on psychophysiology and behavior therapy, The ties of biofeedback/neurofeedback to the biomedical paradigm and to research are stronger than is the case for many other behavioral interventions” (p. 151).The Association for Applied Psychophysiology and Biofeedback
Association for Applied Psychophysiology and Biofeedback
The Association for Applied Psychophysiology and Biofeedback was founded in 1969 as the Biofeedback Research Society . The association aims to promote a new understanding of biofeedback and advance the methods used in this practice...
(AAPB) and the International Society for Neurofeedback and Research (ISNR) have collaborated in validating and rating treatment protocols to address questions about the clinical efficacy of biofeedback and neurofeedback applications, like ADHD and headache. In 2001, Donald Moss, then president of the Association for Applied Psychophysiology and Biofeedback, and Jay Gunkelman, president of the International Society for Neurofeedback and Research, appointed a task force to establish standards for the efficacy of biofeedback and neurofeedback.
The Task Force document was published in 2002, and a series of white papers followed, reviewing the efficacy of a series of disorders. The white papers established the efficacy of biofeedback for functional anorectal disorders, attention deficit disorder, facial pain and temporomandibular disorder, hypertension
Hypertension
Hypertension or high blood pressure is a cardiac chronic medical condition in which the systemic arterial blood pressure is elevated. What that means is that the heart is having to work harder than it should to pump the blood around the body. Blood pressure involves two measurements, systolic and...
, urinary incontinence
Urinary incontinence
Urinary incontinence is any involuntary leakage of urine. It is a common and distressing problem, which may have a profound impact on quality of life. Urinary incontinence almost always results from an underlying treatable medical condition but is under-reported to medical practitioners...
, Raynaud's phenomenon
Raynaud's phenomenon
In medicine, Raynaud's phenomenon is a vasospastic disorder causing discoloration of the fingers, toes, and occasionally other areas. This condition can also cause nails to become brittle with longitudinal ridges. Named for French physician Maurice Raynaud , the phenomenon is believed to be the...
, substance abuse
Substance abuse
A substance-related disorder is an umbrella term used to describe several different conditions associated with several different substances .A substance related disorder is a condition in which an individual uses or abuses a...
, and headache
Headache
A headache or cephalalgia is pain anywhere in the region of the head or neck. It can be a symptom of a number of different conditions of the head and neck. The brain tissue itself is not sensitive to pain because it lacks pain receptors. Rather, the pain is caused by disturbance of the...
.
A broader review was published and later updated, applying the same efficacy standards to the entire range of medical and psychological disorders. The 2008 edition reviewed the efficacy of biofeedback for over 40 clinical disorders, ranging from alcoholism/substance abuse to vulvar vestibulitis
Vulvar vestibulitis
Vulvar Vestibulitis Syndrome , vestibulodynia, or simply vulvar vestibulitis is vulvodynia localized to the vulvar region. It tends to be associated with a highly localized “burning” or “cutting” type of pain....
. The ratings for each disorder depend on the nature of research studies available on each disorder, ranging from anecdotal reports to double blind studies with a control group. Thus, a lower rating may reflect the lack of research rather than the ineffectiveness of biofeedback for the problem.
Efficacy
Yucha and Montgomery's (2008) ratings are listed for the five levels of efficacy recommended by a joint Task Force and adopted by the Boards of Directors of the Association for Applied Psychophysiology (AAPB) and the International Society for Neuronal Regulation (ISNR). From weakest to strongest, these levels include: not empirically supported, possibly efficacious, probably efficacious, efficacious, and efficacious and specific.Level 1: Not empirically supported. This designation includes applications supported by anecdotal reports and/or case studies in non-peer reviewed venues. Yucha and Montgomery (2008) assigned eating disorders, immune function, spinal cord injury
Spinal cord injury
A spinal cord injury refers to any injury to the spinal cord that is caused by trauma instead of disease. Depending on where the spinal cord and nerve roots are damaged, the symptoms can vary widely, from pain to paralysis to incontinence...
, and syncope
Syncope (medicine)
Syncope , the medical term for fainting, is precisely defined as a transient loss of consciousness and postural tone characterized by rapid onset, short duration, and spontaneous recovery due to global cerebral hypoperfusion that most often results from hypotension.Many forms of syncope are...
to this category.
Level 2: Possibly efficacious. This designation requires at least one study of sufficient statistical power with well identified outcome measures but lacking randomized assignment to a control condition internal to the study. Yucha and Montgomery (2008) assigned asthma
Asthma
Asthma is the common chronic inflammatory disease of the airways characterized by variable and recurring symptoms, reversible airflow obstruction, and bronchospasm. Symptoms include wheezing, coughing, chest tightness, and shortness of breath...
, autism
Autism
Autism is a disorder of neural development characterized by impaired social interaction and communication, and by restricted and repetitive behavior. These signs all begin before a child is three years old. Autism affects information processing in the brain by altering how nerve cells and their...
, Bell palsy, cerebral palsy
Cerebral palsy
Cerebral palsy is an umbrella term encompassing a group of non-progressive, non-contagious motor conditions that cause physical disability in human development, chiefly in the various areas of body movement....
, COPD, coronary artery disease, cystic fibrosis
Cystic fibrosis
Cystic fibrosis is a recessive genetic disease affecting most critically the lungs, and also the pancreas, liver, and intestine...
, depression, erectile dysfunction
Erectile dysfunction
Erectile dysfunction is sexual dysfunction characterized by the inability to develop or maintain an erection of the penis during sexual performance....
, fibromyalgia
Fibromyalgia
Fibromyalgia is a medical disorder characterized by chronic widespread pain and allodynia, a heightened and painful response to pressure. It is an example of a diagnosis of exclusion...
, hand dystonia, irritable bowel syndrome
Irritable bowel syndrome
Irritable bowel syndrome is a diagnosis of exclusion. It is a functional bowel disorder characterized by chronic abdominal pain, discomfort, bloating, and alteration of bowel habits in the absence of any detectable organic cause. In some cases, the symptoms are relieved by bowel movements...
, PTSD, repetitive strain injury
Repetitive strain injury
Repetitive strain injury is an injury of the musculoskeletal and nervous systems that may be caused by...
, respiratory failure
Respiratory failure
The term respiratory failure, in medicine, is used to describe inadequate gas exchange by the respiratory system, with the result that arterial oxygen and/or carbon dioxide levels cannot be maintained within their normal ranges. A drop in blood oxygenation is known as hypoxemia; a rise in arterial...
, stroke
Stroke
A stroke, previously known medically as a cerebrovascular accident , is the rapidly developing loss of brain function due to disturbance in the blood supply to the brain. This can be due to ischemia caused by blockage , or a hemorrhage...
, tinnitus
Tinnitus
Tinnitus |ringing]]") is the perception of sound within the human ear in the absence of corresponding external sound.Tinnitus is not a disease, but a symptom that can result from a wide range of underlying causes: abnormally loud sounds in the ear canal for even the briefest period , ear...
, and urinary incontinence
Urinary incontinence
Urinary incontinence is any involuntary leakage of urine. It is a common and distressing problem, which may have a profound impact on quality of life. Urinary incontinence almost always results from an underlying treatable medical condition but is under-reported to medical practitioners...
in children to this category.
Level 3: Probably efficacious. This designation requires multiple observational studies, clinical studies, wait list controlled studies, and within subject and intrasubject replication studies that demonstrate efficacy. Yucha and Montgomery (2008) assigned alcoholism
Alcoholism
Alcoholism is a broad term for problems with alcohol, and is generally used to mean compulsive and uncontrolled consumption of alcoholic beverages, usually to the detriment of the drinker's health, personal relationships, and social standing...
and substance abuse
Substance abuse
A substance-related disorder is an umbrella term used to describe several different conditions associated with several different substances .A substance related disorder is a condition in which an individual uses or abuses a...
, arthritis
Arthritis
Arthritis is a form of joint disorder that involves inflammation of one or more joints....
, diabetes mellitus
Diabetes mellitus
Diabetes mellitus, often simply referred to as diabetes, is a group of metabolic diseases in which a person has high blood sugar, either because the body does not produce enough insulin, or because cells do not respond to the insulin that is produced...
, fecal disorders in children, fecal incontinence
Fecal incontinence
Fecal incontinence is the loss of regular control of the bowels. Involuntary excretion and leaking are common occurrences for those affected. Subjects relating to defecation are often socially unacceptable, thus those affected may be beset by feelings of shame and humiliation...
in adults, insomnia
Insomnia
Insomnia is most often defined by an individual's report of sleeping difficulties. While the term is sometimes used in sleep literature to describe a disorder demonstrated by polysomnographic evidence of disturbed sleep, insomnia is often defined as a positive response to either of two questions:...
, pediatric headache, traumatic brain injury
Traumatic brain injury
Traumatic brain injury , also known as intracranial injury, occurs when an external force traumatically injures the brain. TBI can be classified based on severity, mechanism , or other features...
, urinary incontinence
Urinary incontinence
Urinary incontinence is any involuntary leakage of urine. It is a common and distressing problem, which may have a profound impact on quality of life. Urinary incontinence almost always results from an underlying treatable medical condition but is under-reported to medical practitioners...
in males, and vulvar vestibulitis
Vulvar vestibulitis
Vulvar Vestibulitis Syndrome , vestibulodynia, or simply vulvar vestibulitis is vulvodynia localized to the vulvar region. It tends to be associated with a highly localized “burning” or “cutting” type of pain....
(vulvodynia
Vulvodynia
Vulvodynia is a chronic pain syndrome that affects the vulvar area and occurs without an identifiable cause or visible pathology categorized in the ICD-9 group 625—specifically ICD-9 625.7, which is for pain and other disorders of the female genital organs...
) to this category.
Level 4: Efficacious. This designation requires the satisfaction of six criteria:
(a) In a comparison with a no-treatment control group, alternative treatment group, or sham (placebo) control using randomized assignment, the investigational treatment is shown to be statistically significantly superior to the control condition or the investigational treatment is equivalent to a treatment of established efficacy in a study with sufficient power to detect moderate differences.
(b) The studies have been conducted with a population treated for a specific problem, for whom inclusion criteria are delineated in a reliable, operationally defined manner.
(c) The study used valid and clearly specified outcome measures related to the problem being treated.
(d) The data are subjected to appropriate data analysis.
(e) The diagnostic and treatment variables and procedures are clearly defined in a manner that permits replication of the study by independent researchers.
(f) The superiority or equivalence of the investigational treatment has been shown in at least two independent research settings.
Yucha and Montgomery (2008) assigned anxiety
Anxiety
Anxiety is a psychological and physiological state characterized by somatic, emotional, cognitive, and behavioral components. The root meaning of the word anxiety is 'to vex or trouble'; in either presence or absence of psychological stress, anxiety can create feelings of fear, worry, uneasiness,...
, chronic pain
Chronic pain
Chronic pain has several different meanings in medicine. Traditionally, the distinction between acute and chronic pain has relied upon an arbitrary interval of time from onset; the two most commonly used markers being 3 months and 6 months since the initiation of pain, though some theorists and...
, epilepsy
Epilepsy
Epilepsy is a common chronic neurological disorder characterized by seizures. These seizures are transient signs and/or symptoms of abnormal, excessive or hypersynchronous neuronal activity in the brain.About 50 million people worldwide have epilepsy, and nearly two out of every three new cases...
, constipation
Constipation
Constipation refers to bowel movements that are infrequent or hard to pass. Constipation is a common cause of painful defecation...
(adult), headache
Headache
A headache or cephalalgia is pain anywhere in the region of the head or neck. It can be a symptom of a number of different conditions of the head and neck. The brain tissue itself is not sensitive to pain because it lacks pain receptors. Rather, the pain is caused by disturbance of the...
(adult), hypertension
Hypertension
Hypertension or high blood pressure is a cardiac chronic medical condition in which the systemic arterial blood pressure is elevated. What that means is that the heart is having to work harder than it should to pump the blood around the body. Blood pressure involves two measurements, systolic and...
, motion sickness
Motion sickness
Motion sickness or kinetosis, also known as travel sickness, is a condition in which a disagreement exists between visually perceived movement and the vestibular system's sense of movement...
, Raynaud's disease, and temporomandibular disorder to this category.
Level 5: Efficacious and specific. The investigational treatment must be shown to be statistically superior to credible sham therapy, pill, or alternative bona fide treatment in at least two independent research settings. Yucha and Montgomery (2008) assigned urinary incontinence
Urinary incontinence
Urinary incontinence is any involuntary leakage of urine. It is a common and distressing problem, which may have a profound impact on quality of life. Urinary incontinence almost always results from an underlying treatable medical condition but is under-reported to medical practitioners...
(females) to this category.
Criticisms
In a health care environment that emphasizes cost containment and evidence-based practice, biofeedback and neurofeedback professionals continue to address skepticism in the medical community about the cost-effectiveness and efficacy of their treatments. Critics question how these treatments compare with conventional behavioral and medical interventions on efficacy and cost. The publication of white papers and rigorous evaluation of biofeedback interventions can address these legitimate questions and educate medical professionals, third-party payers, and the public about the value of these services. Biofeedback should gain greater acceptance if researchers can demonstrate that it complements traditional treatments (like physical therapyPhysical therapy
Physical therapy , often abbreviated PT, is a health care profession. Physical therapy is concerned with identifying and maximizing quality of life and movement potential within the spheres of promotion, prevention, diagnosis, treatment/intervention,and rehabilitation...
), achieves comparable or superior efficacy, is more cost effective, and enjoys a better side effect profile.
Organizations
The Association for Applied Psychophysiology and BiofeedbackAssociation for Applied Psychophysiology and Biofeedback
The Association for Applied Psychophysiology and Biofeedback was founded in 1969 as the Biofeedback Research Society . The association aims to promote a new understanding of biofeedback and advance the methods used in this practice...
(AAPB) is a non-profit scientific and professional society for biofeedback and neurofeedback. The International Society for Neurofeedback and Research (ISNR) is a non-profit scientific and professional society for neurofeedback. The Biofeedback Foundation of Europe (BFE) sponsors international education, training, and research activities in biofeedback and neurofeedback. The Northeast Regional Biofeedback Association (NRBS) sponsors theme centered educational conferences, political advocacy for biofeedback friendly legislation, and research activities in biofeedback and neurofeedback in the Northeast regions of the United States.
Certification
The Biofeedback Certification International AllianceBiofeedback Certification International Alliance
The Biofeedback Certification International Alliance was created in 1981 as a non-profit organization. BCIA is a member of the Institute for Credentialing Excellence...
(formerly the Biofeedback Certification Institute of America) is a non-profit organization that is a member of the Institute for Credentialing Excellence
Institute for Credentialing Excellence
Institute for Credentialing Excellence is one of the two main organizations that accredit personnel certifications or certificates. In November 2009 the ICE formally changed its name from the National Organization for Competency Assurance ....
(ICE). BCIA offers biofeedback certification, neurofeedback (also called EEG biofeedback) certification, and pelvic muscle dysfunction biofeedback. BCIA certifies individuals who meet education and training standards in biofeedback and neurofeedback and progressively recertifies those who satisfy continuing education requirements. BCIA certification has been endorsed by the Mayo Clinic, the Association for Applied Psychophysiology and Biofeedback
Association for Applied Psychophysiology and Biofeedback
The Association for Applied Psychophysiology and Biofeedback was founded in 1969 as the Biofeedback Research Society . The association aims to promote a new understanding of biofeedback and advance the methods used in this practice...
(AAPB), the International Society for Neurofeedback and Research (ISNR), and the Washington State Legislature.
The BCIA didactic education requirement includes a 48-hour course from a regionally-accredited academic institution or a BCIA-approved training program that covers the complete General Biofeedback Blueprint of Knowledge and study of human anatomy and physiology. The General Biofeedback Blueprint of Knowledge areas include: I. Orientation to Biofeedback, II. Stress, Coping, and Illness, III. Psychophysiological Recording, IV. Surface Electromyographic (SEMG) Applications, V. Autonomic Nervous System (ANS) Applications, VI. Electroencephalographic (EEG) Applications, VII. Adjunctive Interventions, and VIII. Professional Conduct.
Applicants may demonstrate their knowledge of human anatomy and physiology by completing a course in human anatomy, human physiology, or human biology provided by a regionally-accredited academic institution or a BCIA-approved training program or by successfully completing an Anatomy and Physiology exam covering the organization of the human body and its systems.
Applicants must also document practical skills training that includes 20 contact hours supervised by a BCIA-approved mentor designed to them teach how to apply clinical biofeedback skills through self-regulation training, 50 patient/client sessions, and case conference presentations. Distance learning allows applicants to complete didactic course work over the internet. Distance mentoring trains candidates from their residence or office. They must recertify every 4 years, complete 55 hours of continuing education during each review period or complete the written exam, and attest that their license/credential (or their supervisor’s license/credential) has not been suspended, investigated, or revoked.
Pelvic muscle dysfunction
Pelvic Muscle Dysfunction Biofeedback (PMDB) encompasses "elimination disorders and chronic pelvic pain syndromes." The BCIA didactic education requirement includes a 28-hour course from a regionally-accredited academic institution or a BCIA-approved training program that covers the complete Pelvic Muscle Dysfunction Biofeedback Blueprint of Knowledge and study of human anatomy and physiology. The Pelvic Muscle Dysfunction Biofeedback areas include: I. Applied Psychophysiology and Biofeedback, II. Pelvic Floor Anatomy, Assessment, and Clinical Procedures, III. Clinical Disorders: Bladder Dysfunction, IV. Clinical Disorders: Bowel Dysfunction, and V. Chronic Pelvic Pain Syndromes.Currently, only licensed health care providers may apply for this certification. Applicants must also document practical skills training that includes a 4-hour practicum/personal training session and 12 contact hours spent with a BCIA-approved mentor designed to them teach how to apply clinical biofeedback skills through 30 patient/client sessions and case conference presentations. They must recertify every 3 years, complete 36 hours of continuing education or complete the written exam, and attest that their license/credential has not been suspended, investigated or revoked.
History
Claude BernardClaude Bernard
Claude Bernard was a French physiologist. He was the first to define the term milieu intérieur . Historian of science I. Bernard Cohen of Harvard University called Bernard "one of the greatest of all men of science"...
proposed in 1865 that the body strives to maintain a steady state in the internal environment (milieu intérieur
Milieu interieur
Milieu intérieur or interior milieu, from the French, milieu intérieur, is a term coined by Claude Bernard to refer to the extra-cellular fluid environment, and its physiological capacity to ensure protective stability for the tissues and organs of multicellular living organisms.-Origin:Claude...
), introducing the concept of homeostasis
Homeostasis
Homeostasis is the property of a system that regulates its internal environment and tends to maintain a stable, constant condition of properties like temperature or pH...
. In 1885, J.R. Tarchanoff showed that voluntary control of heart rate could be fairly direct (cortical-autonomic) and did not depend on "cheating" by altering breathing rate. In 1901, J. H. Bair studied voluntary control of the retrahens aurem muscle that wiggles the ear
Ear
The ear is the organ that detects sound. It not only receives sound, but also aids in balance and body position. The ear is part of the auditory system....
, discovering that subjects learned this skill by inhibiting interfering muscles and demonstrating that skeletal muscles are self-regulated. Alexander Graham Bell
Alexander Graham Bell
Alexander Graham Bell was an eminent scientist, inventor, engineer and innovator who is credited with inventing the first practical telephone....
attempted to teach the deaf to speak through the use of two devices - the phonautograph
Phonautograph
The phonautograph is the earliest known device for recording sound. Previously, tracings had been obtained of the sound-producing vibratory motions of tuning forks and other objects by physical contact with them, but not of actual sound waves as they propagated through air or other media. Invented...
, created by Édouard-Léon Scott’s
Édouard-Léon Scott de Martinville
Édouard-Léon Scott de Martinville was a French printer and bookseller who lived in Paris. He invented the earliest known sound recording device, the phonautograph, which was patented in France on 25 March 1857....
, and a manometric flame
Pressure measurement
Many techniques have been developed for the measurement of pressure and vacuum. Instruments used to measure pressure are called pressure gauges or vacuum gauges....
. The former translated sound vibrations into tracings on smoked glass to show their acoustic waveforms, while the latter allowed sound to be displayed as patterns of light. After World War II
World War II
World War II, or the Second World War , was a global conflict lasting from 1939 to 1945, involving most of the world's nations—including all of the great powers—eventually forming two opposing military alliances: the Allies and the Axis...
, mathematician Norbert Wiener
Norbert Wiener
Norbert Wiener was an American mathematician.A famous child prodigy, Wiener later became an early researcher in stochastic and noise processes, contributing work relevant to electronic engineering, electronic communication, and control systems.Wiener is regarded as the originator of cybernetics, a...
developed cybernetic theory
Cybernetics
Cybernetics is the interdisciplinary study of the structure of regulatory systems. Cybernetics is closely related to information theory, control theory and systems theory, at least in its first-order form...
, that proposed that systems are controlled by monitoring their results. The participants at the landmark 1969 conference at the Surfrider Inn in Santa Monica coined the term biofeedback from Weiner's feedback
Feedback
Feedback describes the situation when output from an event or phenomenon in the past will influence an occurrence or occurrences of the same Feedback describes the situation when output from (or information about the result of) an event or phenomenon in the past will influence an occurrence or...
. The conference resulted in the founding of the Bio-Feedback Research Society, which permitted normally isolated researchers to contact and collaborate with each other, as well as popularizing the term “biofeedback.” The work of B.F. Skinner led researchers to apply operant conditioning
Operant conditioning
Operant conditioning is a form of psychological learning during which an individual modifies the occurrence and form of its own behavior due to the association of the behavior with a stimulus...
to biofeedback, decide which responses could be voluntarily controlled and which could not. The effects of the perception of autonomic nervous system activity was initially explored by George Mandler
George Mandler
George Mandler is Distinguished Professor of Psychology Emeritus at the University of California, San Diego.Mandler was born in Vienna on 11 June 1924. He received his B.S. from New York University and his Ph. D. degree from Yale University in 1953. He served in the U.S. Army Military Intelligence...
's group in 1958. In 1965, Maia Lisina combined classical and operant conditioning to train subjects to change blood vessel diameter, eliciting and displaying reflexive blood flow changes to teach subjects how to voluntarily control the temperature of their skin. In 1974, H.D. Kimmel trained subjects to sweat using the galvanic skin response
Galvanic skin response
Skin conductance, also known as galvanic skin response , electrodermal response , psychogalvanic reflex , skin conductance response or skin conductance level , is a method of measuring the electrical conductance of the skin, which varies with its moisture level...
.
Hinduism:
Biofeedback systems have been known in India and some other countries for millenia. Ancient Hindu practices like Yoga and Pranayama (Breathing techniques)are essentially biofeedback methods. Many yogis and sadhus have been known to exercise control over their physiological processes. In addition to recent research on Yoga, Paul Brunton, the British writer who travelled extensively in India, has written about many cases he has witnessed.
Timeline
1958 - G. Mandler's group studied the process of autonomic feedback and its effects.1962 - D. Shearn used feedback instead of conditioned stimuli to change heart rate.
1962 - Publication of Muscles Alive by John Basmajian and Carlo De Luca
1968 - Annual Veteran's Administration research meeting in Denver that brought together several biofeedback researchers
1969 - Conference on Altered States of Consciousness in Council Grove, Kansas in April and first meeting of the Bio-Feedback Research Society (BRS) at the Surfrider Inn in Santa Monica in October
1972 - Review and analysis of early biofeedback studies by D. Shearn in the 'Handbook of Psychophysiology'.
1975 - American Association of Biofeedback Clinicians was founded
1976 - BRS was renamed the Biofeedback Society of America (BSA)
1977 - Publication of Beyond Biofeedback by Elmer and Alyce Green and Biofeedback: Methods and Procedures in Clinical Practice by George Fuller
1978 - Publication of Biofeedback: A Survey of the Literature by Francine Butler
1979 - Publication of Biofeedback: Principles and Practice for Clinicians by John Basmajian and Mind/Body Integration: Essential Readings in Biofeedback by Erik Peper, Sonia Ancoli, and Michele Quinn
1980 - Biofeedback Certification Institute of America (BCIA) offered the first national certification examination in biofeedback and publication of Biofeedback: Clinical Applications in Behavioral Medicine by David Olton and Aaron Noonberg
1984 - Publication of Principles and Practice of Stress Management by Woolfolk and Lehrer
1987 - Publication of Biofeedback: A Practitioner's Guide by Mark Schwartz
1989 - BSA was renamed the Association for Applied Psychophysiology and Biofeedback
1991 - BCIA offered first national certification examination in stress management
1994 - Brain Wave and EMG sections were established within AAPB
1995 - Society for the Study of Neuronal Regulation (SSNR) was founded
1996 - Biofeedback Foundation of Europe (BFE) was established
1999 - SSNR was renamed the Society for Neuronal Regulation (SNR)
2002 - SNR was renamed the International Society for Neuronal Regulation (iSNR)
2003 - Publication of The Neurofeedback Book by Thompson and Thompson
2004 - Publication of Evidence-Based Practice in Biofeedback and Neurofeedback by Carolyn Yucha and Christopher Gilbert
2006 - ISNR was renamed the International Society for Neurofeedback & Research (ISNR)
2008 - Biofeedback Neurofeedback Alliance was formed to pool the resources of the AAPB, BCIA, and ISNR on joint initiatives
2008 - Biofeedback Alliance and Nomenclature Task Force defined biofeedback
2009 - The International Society for Neurofeedback & Research defined neurofeedback
2010 - Biofeedback Certification Institute of America renamed Biofeedback Certification International Alliance (BCIA)
In popular culture
- Biofeedback data and biofeedback technology are used by Massimiliano Peretti in a contemporary art environment, the AmigdalaeAmigdalaeAmigdalae is a biofeedback based art project by the artist Massimiliano Peretti. The project has been presented for the first time in a scientific environment at the CNRS, National Center of Scientific Research in Paris, November 2005...
project. This project explores the way in which emotional reactions filter and distort human perceptionPerceptionPerception is the process of attaining awareness or understanding of the environment by organizing and interpreting sensory information. All perception involves signals in the nervous system, which in turn result from physical stimulation of the sense organs...
and observation. During the performance, biofeedback medical technology, such as the EEGEEGEEG commonly refers to electroencephalography, a measurement of the electrical activity of the brain.EEG may also refer to:* Emperor Entertainment Group, a Hong Kong-based entertainment company...
, body temperature variations, heart rateHeart rateHeart rate is the number of heartbeats per unit of time, typically expressed as beats per minute . Heart rate can vary as the body's need to absorb oxygen and excrete carbon dioxide changes, such as during exercise or sleep....
, and galvanic responses, are used to analyze an audience's emotions while they watch the video art. Using these signals, the music changes so that the consequent sound environment simultaneously mirrors and influences the viewer's emotional state. More information is available at the website of the CNRS French National Center of Neural Research http://cogimage.dsi.cnrs.fr/seminaires/resumes/resume_amygdalae_2005.htm. - Charles Wehrenberg implemented competitive-relaxation as a gaming paradigm with the Will Ball Games circa 1973. In the first bio-mechanical versions, comparative GSR inputs monitored each player's relaxation response and moved the Will Ball across a playing field appropriately using stepper motors. In 1984 Wehrenberg programmed the Will Ball games for Apple II computers. The Will Ball game itself is described as pure competitive-relaxation; Brain Ball is a duel between one player's left and right brain hemispheres; Mood Ball is an obstacle-based game; Psycho Dice is a psycho-kinetic game. In 1999 The HeartMath Institute developed an educational system based on heart rhythm measurement and display on a Personal Computer (Windows/Macintosh). Their systems have been copied by many but are still unique in the way they assist people to learn about and self-manage their physiology. A handheld version of their system was released in 2006 and is completely portable being the size of a small mobile phone and having rechargeable batteries. With this unit one can move around and go about daily business while gaining feedback about inner psycho-physiological states.
- In 2001, the company Journey to Wild DivineJourney to Wild DivineJourney to Wild Divine is a biofeedback video game system promoting stress management and overall wellness through the use of breathing, meditation and relaxation exercises. The graphics and interface resemble Myst...
began producing biofeedback hardware and software for the MacintoshMacintoshThe Macintosh , or Mac, is a series of several lines of personal computers designed, developed, and marketed by Apple Inc. The first Macintosh was introduced by Apple's then-chairman Steve Jobs on January 24, 1984; it was the first commercially successful personal computer to feature a mouse and a...
and WindowsMicrosoft WindowsMicrosoft Windows is a series of operating systems produced by Microsoft.Microsoft introduced an operating environment named Windows on November 20, 1985 as an add-on to MS-DOS in response to the growing interest in graphical user interfaces . Microsoft Windows came to dominate the world's personal...
operating systemOperating systemAn operating system is a set of programs that manage computer hardware resources and provide common services for application software. The operating system is the most important type of system software in a computer system...
s. Third-party and open-source software and games are also available for the Wild Divine hardware. Tetris 64Tetris 64is a puzzle game for the Nintendo 64. It was released only in Japan in 1998. The whole game is in English. It is the only Nintendo 64 game that can make use of the Nintendo 64's bio sensor which was included with the game....
makes use of biofeedback to adjust the speed of the tetris puzzle game. - David RosenboomDavid RosenboomDavid Rosenboom is an American composer and a pioneer in the use of neurofeedback, cross-cultural collaborations and compositional algorithms...
has worked to develop musical instruments that would respond to mental and physiological commands. Playing these instruments can be learned through a process of biofeedback. - In the mid-seventies, an episode of the television series, "The Bionic Woman", featured a doctor who could "heal" himself using biofeedback techniques to communicate to his body and react to stimuli. For example, he could exhibit "super" powers, such as walking on hot coals, by feeling the heat on the sole of his feet and then convincing his body to react by sending large quantities of perspiration to compensate. He could also convince his body to deliver extremely high levels of adrenalin to provide more energy to allow him to run faster and jump higher. When injured, he could slow his heart rate to reduce blood pressure, send extra platelets to aid in clotting a wound, and direct white blood cells to an area to attack infection.http://www.imdb.com/title/tt0526163