Biofeedback is back

Not a quick fix but a long-term solution

The major advantages of biofeedback are that it is noninvasive, has virtually no side effects, and is effective over the long-term. The major disadvantage for some is that it requires effort, commitment, and involvement on the part of patients.

"With biofeedback, you do the work rather than having it done to you," says Kim Larsson, a biofeedback clinician at Harvard Vanguard Medical Associates, a large Boston-based group practice. "But if you are ready and willing to do the work, it can be incredibly powerful." Larsson's program typically involves 12 individual training sessions beginning weekly and then spreading out over a year, along with five to ten minutes of "homework" daily. Half the battle, Larsson stresses, is not just learning the biofeedback during the training sessions, but learning to integrate it into your whole life. "Usually, the results are satisfying, quick, and very reinforcing," she adds, making the effort well worth it for most patients.

How biofeedback works

Every time you scratch an itch, grab a snack when you're hungry, or use the bathroom when you feel the urge, you are responding to biofeedback cues from your body about your physiologic state.

With biofeedback training, however, you are cued by sensors attached to your body. These sensors measure heart rate, the temperature of your extremities, the muscle tension in specific muscle groups, or, in neurofeedback, the kinds of brain waves you are emitting. This information is conveyed by visual displays or sounds. Using imagery and mental exercises, you learn to control these functions, using the feedback provided by the sensors as a gauge of success. With practice, you can learn to "tune in" without instrumentation, and control these functions at will during ordinary life.

For example, in a biofeedback training session for headache, Larsson would attach temperature sensors first to your hands, then to your feet, and finally to your forehead, if needed. Your goal would be to increase blood flow away from the brain by raising the temperature in your hands and feet and eventually lowering it in your temples. Other sensors might monitor your electrodermal or galvanic skin response how easily you sweat or get "goosebumps" because this affects your ability to alter your skin temperature.

To warm up your hands and feet, you might imagine basking in the sun on a beach while listening to a script like "I feel warm...my hands are growing warm and heavy..." Both the image and the script would be tailored to you personally to evoke a vivid and relaxing mental image. After your training session, you'd be sent home with this script on audiotape and small thermometers to use for your daily practice.

How effective is biofeedback?

The type of problem being treated and the motivation of the patient are often the key determinants of biofeedback success. For problems like Raynaud's disease or bed wetting in children, biofeedback has shown some effectiveness, but success rates vary widely. Success rates for established biofeedback protocols for incontinence, anxiety, headaches, and hypertension vary, but most studies report significant improvement in many participants.

"There has been a lot of controversy over headache," says Larsson. "Some studies found that biofeedback was not effective, and others found that it was, although not necessarily better than other treatments." However, she notes that many of her patients come to her program because of incapacitating migraines for which other treatments have failed, and she finds that most of these patients have positive results with biofeedback.

The benefits of biofeedback therapy are usually permanent, but success is predicated on the fact that most patients must consciously continue practicing what they have learned. Many practitioners view biofeedback not as a treatment, but as an education.

Any biofeedback treatment program should involve your primary health care provider and relevant specialists, such as urologists, cardiologists, or neurologists. The training is often most effective when integrated with other types of therapy, such as medication or cognitive behavioral therapy. Sometimes, as was found in one study of patients with essential hypertension, biofeedback therapy can allow you to substantially cut back or even eliminate some medications.

Neurofeedback the biofeedback frontier

Neurofeedback, also called EEG feedback, is the most controversial form of biofeedback therapy, largely because so few controlled clinical trials have been able to assess its efficacy. Preliminary clinical data suggest that it may be effective in the treatment of ADHD, hyperkinesis, depression, epilepsy, and alcoholism. Other areas of investigation include the treatment of premenstrual syndrome, stroke rehabilitation, anxiety, Tourette syndrome, and chronic fatigue syndrome. Like all biofeedback, neurofeedback is noninvasive and has few or no side effects, although some subjects feel temporarily dizzy or disoriented after a training session.

In a neurofeedback training session, several sensors that measure your brain's electrical activity are attached to your scalp. You relax and play a video game, which is controlled just by your brain waves and responds favorably to brain waves of the desired pattern. As you play the game, your trainer observes your EEG, transmitted to a separate video terminal. Most practitioners recommend at least 20 sessions to obtain significant, long-lasting results, although improvement is usually noted early on if the treatment protocol is right for you.

A note of caution: because the field is so new, many practitioners have little or no experience beyond a week-long training session, so ask lots of questions and talk with your primary care provider before embarking on a treatment program.

Cost of biofeedback training

Some insurance companies and HMOs offer partial coverage for biofeedback. The cost of an individual training session ranges from $40.00 to $125.