Imagine having hands so sensitive to cold that each winter they would swell and split open, so that just grabbing a carton of milk out of the refrigerator makes them whiten and throb with pain. Then imagine learning to raise the temperature in your hands so that you could hold the carton of milk and do it without any pain. This is an example of what biofeedback training is attempting to accomplish for certain medical problems. In this case, the problem is Raynaud disease, a circulatory disorder that can cause extreme discomfort and debilitation. Unfortunately, biofeedback studies on Raynaud disease have not proven effective.
Currently, incomplete but encouraging evidence suggests that biofeedback may indeed offer at least modest benefits for a variety of conditions, including anxiety, low back pain, insomnia, and female stress incontinence. There is mixed evidence as to whether biofeedback helps with migraine and tension headaches.
The major advantages of biofeedback are that it is noninvasive, has virtually no side effects, and is possibly effective over the long-term. Before going forward with biofeedback, you should be aware that it will require lots of effort, commitment, and involvement.
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 physiological 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 converted and 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, temperature sensors would be attached 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 goose bumps, 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 would be sent home with an audio version of the script and small thermometers to use for your daily practice.
Any biofeedback treatment program should involve your primary healthcare provider and relevant specialists, such as urologists, cardiologists, or neurologists. Biofeedback is often most effective when integrated with other types of therapy, such as medication or cognitive-behavioral therapy.
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. Neurofeedback is the retraining of brainwave patterns. Although controversial, it is experiencing a resurgence of interest in the treatment of a variety of disorders, including depression, fibromyalgia, attention-deficit hyperactivity disorder (ADHD), and alcoholism.
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 electroencephalogram (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: Be sure that the practitioner that you choose to work with has training and experience in using neurofeedback. Ask lots of questions and talk with your primary care doctor before starting a treatment program.
Applied Psychophysiology and Biofeedback http://www.aapb.org
Biofeedback Certification Institute of America http://www.bcia.org
Behavioral interventions for urinary incontinence. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated June 2, 2016. Accessed July 31, 2017.
Biofeedback. EBSCO Natural and Alternative Treatments website. Available at: http://www.ebscohost.com/biomedical-libraries/natural-alternative-treatments. Updated September 18, 2014. Accessed July 31, 2017.
Consumers. Applied Psychophysiology and Biofeedback website. Available at: Biofeedback http://www.aapb.org/i4a/pages/index.cfm?pageid=3287. Accessed August 12, 2015.
Hermann C, Blanchard EB. Biofeedback in the treatment of headache and other childhood pain. Appl Psychophysiol Biofeedback. 2002;27(2):143-162.
Migraine in adults. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us. Updated August 9, 2016. Accessed July 31, 2017.
Moore NC. A review of EEG biofeedback treatment of anxiety disorders. Clin Electroencephalogr. 2000;31:1-6.
What is neurofeedback? Trauma Center at Justice Resource Institute website. Available at: http://www.traumacenter.org/clients/neurofeedback.php. Accessed July 31, 2017.
- Reviewer: EBSCO Medical Review Board Michael Woods, MD
- Review Date: 08/2015
- Update Date: 08/12/2015