Biofeedback Therapy; Types, Uses, Efficacy, Eligibility Criteria.

Biofeedback Therapy is a non-drug treatment in which patients learn to control bodily processes that are normally involuntary, such as muscle tension, blood pressure, or heart rate.It is the process of gaining greater awareness of many physiological functions primarily using instruments that provide information on the activity of those same systems, with a goal of being able to manipulate them at will. Some of the processes that can be controlled include brainwaves, muscle tone, skin conductance, heart rate and pain perception.

Types or measurment procedures/instruments of Biofeedback Therapy

Several different relaxation exercises are used in biofeedback therapy, including:

  • Progressive muscle relaxation – alternately tightening and then relaxing different muscle groups
  • Guided imagery – concentrating on a specific image (such as the color and texture of an orange) to focus your mind and make you feel more relaxed
  • Mindfulness meditation — focusing your thoughts and letting go of negative emotions
  • Brainwave – This type of method uses scalp sensors to monitor your brain waves using an electroencephalograph (EEG).
  • Deep breathing – During respiratory biofeedback, bands are placed around your abdomen and chest to monitor your breathing pattern and respiration rate.
  • Heart rate – This type of biofeedback uses finger or earlobe sensors with a device called a photoplethysmograph or sensors placed on your chest, lower torso or wrists using an electrocardiograph (ECG) to measure your heart rate and heart rate variability.
  • Muscle – This method of biofeedback involves placing sensors over your skeletal muscles with an electromyography (EMG) to monitor the electrical activity that causes muscle contraction.
  • Sweat glands – Sensors attached around your fingers or on your palm or wrist with an electrodermograph (EDG) measure the activity of your sweat glands and the amount of perspiration on your skin, alerting you to anxiety.
  • Temperature – Sensors attached to your fingers or feet measure your blood flow to your skin. Because your temperature often drops when you’re under stress, a low reading can prompt you to begin relaxation techniques.

Different types of biofeedback are used to monitor different body functions

Electromyogram (EMG) – This measures muscle activity and tension. It may be used for back pain, headaches, anxiety disorders, muscle retraining after injury, and incontinence.
Thermal – This measures skin temperature. It may be used for headacheand Raynaud’s disease.
Neurofeedback or electroencephalography (EEG) – This measures brain waves. It may be used for attention deficit hyperactivity disorder (ADHD), epilepsy and other seizure disorders.
Galvanic skin response training – Sensors measure the activity of a person’s sweat glands and the amount of perspiration on the skin, indicating the presence of anxiety. This information can be useful in treating emotional disorders such as phobias, anxiety and stuttering.
Electrodermal activity (EDA) –This measures sweating and can be used for pain and anxiety.Heart rate variability (HRA) – This measures heart rate. It may be used for anxiety, asthma, chronic obstructive pulmonary disease (COPD), and irregular heartbeat.

Electromyography (EMG) biofeedback – measures muscle tension as it changes over time

Thermal or temperature biofeedback – measures body temperature changes over time

Electroencephalography – measures brain wave activity over time

Galvanic skin response training – measures the amount of sweat on your body over time

Heart variability biofeedback – measures your pulse and heart rate

Therapy catagory 

Indications/ Uses of Biofeedback Therapy

Biofeedback can help many different conditions. Here is a rundown of some biofeedback benefits
Chronic pain By helping you identify tight muscles and then learn to relax those muscles, biofeedback may help relieve the discomfort of conditions like low back pain, abdominal pain, temporomandibular joint disorders (TMJ), and fibromyalgia. For pain relief, biofeedback can benefit people of all ages, from children to older adults.
Headaches – Headaches are one of the best-studied biofeedback uses. Muscle tension and stress can trigger migraines and other types of headaches, and can make headache symptoms worse. There is good evidence that biofeedback therapy can relax muscles and ease stress to reduce both the frequency and severity of headaches. Biofeedback seems to be especially beneficial for headaches when it’s combined with medications.Anxiety – Anxiety relief is one of the most common uses of biofeedback. Biofeedback lets you become more aware of your body’s responses when you’re stressed and anxious. Then you can learn how to control those responses.
Urinary Incontinence – Biofeedback therapy can help people who have trouble controlling the urge to use the bathroom. Biofeedback can help women find and strengthen the pelvic floor muscles that control bladder emptying. After several sessions of biofeedback, women with incontinence may be able to reduce their urgent need to urinate and the number of accidents they have.
High Blood Pressure – Evidence on the use of biofeedback for high blood pressure has been mixed. Although the technique does seem to lower blood pressure slightly, biofeedback isn’t as effective as medication for blood pressure control.Other biofeedback uses include

Main test categories of Biofeedback Therapy

  • Nutritional Deficiencies and Hormonal Imbalance.
  • Allergies and Food Sensitivities
  • Toxicities, Fungi, and Parasites
  • Physical Body – Organs, Muscles, Glands, Blood, and More
  • Brain Wave Patterns.
  • Emotional Blockages and Mental Stress, Chakras.
  • The Top Most Reactive Issues With the Risks Profile.
  • Skin, hair, saliva, and urine testing.
  • Supplements and Drugs Energetic Compatibility.

Efficacy of Biofeedback Therapy

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, 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, autismBell 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 efficaciousThis designation requires multiple observational studies, clinical studies, waitlist-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

  • 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.
  • 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.
  • The study used valid and clearly specified outcome measures related to the problem being treated.
  • The data are subjected to appropriate data analysis.
  • The diagnostic and treatment variables and procedures are clearly defined in a manner that permits replication of the study by independent researchers.
  • The superiority or equivalence of the investigational treatment has been shown in at least two independent research settings.

Yucha and Montgomery (2008) assigned attention deficit hyperactivity disorder (ADHD), a chronic pain, epilepsy, constipation (adult), headache (adult), hypertension, motion sickness, Raynaud’s disease, and temporomandibular joint dysfunction 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.

Criteria eligibity of Information from the National Library of Medicine

Inclusion Criteria

During the previous year, all patients must have experienced or reported at least two of the following symptoms for at least three months and with 25% of bowel movements (when not taking laxatives)

  • Patient must be right-handed
  • stool frequency of less than three/week,
  • passage of hard stools,
  • excessive straining,
  • a feeling of incomplete evacuation,
  • sensation of anorectal obstruction or blockage and
  • use of manual maneuvers to facilitate defecations (e.g., digital evacuation).
  • No evidence of structural disease (excluded by colonoscopy)
  • Enema and metabolic problem by lab tests.
  • Patients on stable doses of antidepressants without anticholinergic effects will be included.
  • Patient must be undergoing biofeedback treatment
  • Patient must be right-handed
Exclusion Criteria
  • Patients taking drugs that are constipating, (e.g.; calcium channel antagonists will either be excluded or drug discontinued)
  • Patients with comorbid illnesses; severe cardiac disease, chronic renal failure or previous gastrointestinal surgery except cholecystectomy and appendectomy.
  • Neurologic diseases e.g.; head injury.epilepsy,multiple sclerosis, strokes, spinal cord injuries.
  • Impaired cognizance (mini mental score of < 15) and/or legally blind.
  • Pregnant or likely to conceive during the course of the study. Women with potential for pregnancy must be willing to use contraceptive measures during the study. Urinary pregnancy tests will be performed on such women prior to any radiologic procedures.
  • Hirschsprung’s disease.
  • Alternating constipation and diarrhea 
  • Ulcerative and Crohns colitis.
  • Previous pelvic surgery, rectocele repair, bladder repair, radical hysterectomy.
  • Rectal prolapse or anal fissure or anal surgery.
  • Presence of metal in the skull, cranial cavity, back or hips.
  • People who have a cardiac pacemaker, an implanted defibrillator, or a medication pump.


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