Biofeedback 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. In biofeedback, you are connected to electrical sensors that help you receive information (feedback) about your body (bio).
Biofeedback may be used to improve health, performance, and the physiological changes that often occur in conjunction with changes to thoughts, emotions, and behavior. Eventually, these changes may be maintained without the use of extra equipment, for no equipment is necessarily required to practice biofeedback.
A diagram showing the feedback loop between person, sensor, and processor to help provide biofeedback training
Information coded biofeedback is an evolving form and methodology in the field of biofeedback. Its uses may be applied in the areas of health, wellness and awareness. Biofeedback has its modern conventional roots in the early 1970s.
Over the years, biofeedback as a discipline and a technology has continued to mature and express new versions of the method with novel interpretations in areas utilizing the electromyograph, electrodermograph, electroencephalograph and electrocardiogram among others. The concept of biofeedback is based on the fact that a wide variety of ongoing intrinsic natural functions of the organism occur at a level of awareness generally called the "unconscious". The biofeedback process is designed to interface with select aspects of these "unconscious" processes.
The definition reads: Biofeedback is a process that enables an individual to learn how to change physiological activity for the purposes of improving health and performance. Precise instruments measure physiological activity such as brainwaves, heart function, breathing, muscle activity, and skin temperature. These instruments rapidly and accurately feed back information to the user. The presentation of this information—often in conjunction with changes in thinking, emotions, and behavior—supports desired physiological changes. Over time, these changes can endure without continued use of an instrument.
A more simple definition could be: Biofeedback 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. (Emphasis added by author.)
In both of these definitions, a cardinal feature of the concept is the association of the "will" with the result of a new cognitive "learning" skill. Some examine this concept and do not necessarily ascribe it simply to a willful acquisition of a new learned skill but also extend the dynamics into the realms of a behavioristic conditioning (7). Behaviorism contends that it is possible to change the actions and functions of an organism by exposing it to a number of conditions or influences. Key to the concept is not only that the functions are unconscious but that conditioning processes themselves may be unconscious to the organism. Information coded biofeedback relies primarily on the behavior conditioning aspect of biofeedback in promoting significant changes in the functioning of the organism.
The principle of "information" is both complex and, in part, controversial. The term itself is derived from the Latin verb informare which means literally "to bring into form or shape". The meaning of "information" is largely affected by the context of usage. Probably the simplest and perhaps most insightful definition of "information" was given by Gregory Bateson—"Information is news of change" or another as "the difference that makes a difference". Information may also be thought of as "any type of pattern that influences the formation or transformation of other patterns". Recognizing the inherent complexity of an organism, information coded biofeedback applies algorithmic calculations in a stochastic approach to identify significant probabilities in a limited set of possibilities.
An electromyograph (EMG) 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).
In addition to surface electrodes, clinicians may also insert wires or needles intramuscularly to record an EMG signal. While this is more painful and often costly, the signal is more reliable since surface electrodes pick up cross talk from nearby muscles. The use of surface electrodes is also limited to superficial muscles, making the intramuscular approach beneficial to access signals from deeper muscles. The electrical activity picked up by the electrodes is recorded and displayed in the same fashion as the surface electrodes. Prior to placing surface electrodes, the skin is normally shaved, cleaned and exfoliated to get the best signal. Raw EMG signals resemble noise (electrical signal not coming from the muscle of interest) and the voltage fluctuates, therefore they are processed normally in three ways: rectification, filtering, and integration. This processing allows for a unified signal that is then able to be compared to other signals using the same processing techniques.
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 dysfunction (TMD), torticollis, and fecal incontinence, urinary incontinence, and pelvic pain. Physical therapists have also used EMG biofeedback for evaluating muscle activation and providing feedback for their patients.
A feedback thermometer detects skin temperature with a thermistor (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 adrenergic 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.
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 electric 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). 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.
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 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 thresholds or boundaries 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.
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.
A photoplethysmograph (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.
The electrocardiogram (ECG) uses electrodes placed on the torso, wrists, or legs, to measure the electrical activity of the heart and measures the interbeat interval (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 heart rate variability (HRV) biofeedback when treating asthma, COPD, depression, anxiety, fibromyalgia, heart disease, and unexplained abdominal pain. Research shows that HRV biofeedback can also be used to improve physiological and psychological wellbeing in healthy individuals.
HRV data from both polyplethysmographs and electrocardiograms are analyzed via mathematical transformations such as the commonly-used fast Fourier transform (FFT). The FFT splits the HRV data into a power spectrum, revealing the waveform's constituent frequencies. Among those constituent frequencies, high-frequency (HF) and low-frequency (LF) components are defined as above and below .15 Hz, respectively. As a rule of thumb, the LF component of HRV represents sympathetic activity, and the HF component represents parasympathetic activity. The two main components are often represented as a LF/HF ratio and used to express sympathovagal balance. Some researchers consider a third, medium-frequency (MF) component from .08 Hz to .15 Hz, which has been shown to increase in power during times of appreciation.
A pneumograph 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.
Biofeedback therapists use pneumograph biofeedback with patients diagnosed with anxiety disorders, asthma, chronic pulmonary obstructive disorder (COPD), essential hypertension, panic attacks, and stress.
A capnometer or capnograph uses an infrared detector to measure end-tidal CO
2 (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 CO
2 for a resting adult is 5% (36 Torr or 4.8 kPa). A capnometer is a sensitive index of the quality of patient breathing. Shallow, rapid, and effortful breathing lowers CO
2, 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.
Rheoencephalography (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 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.
Pressure can be monitored as a patient performs exercises while resting against an air-filled cushion. This is pertinent to physiotherapy. Alternatively, the patient may actively grip or press against an air-filled cushion of custom shape.
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 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. Contradicting this, a 2013 randomized controlled trial found no benefit of adding biofeedback to pelvic floor muscle exercise in stress urinary incontinence. In another randomized controlled trial the addition of biofeedback to the training of pelvic floor muscles for the treatment of stress urinary incontinence, improved pelvic floor muscle function, reduced urinary symptoms, and improved of the quality of life.
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.
Biofeedback is a major treatment for anismus (paradoxical contraction of puborectalis during defecation). This therapy directly evolved from the investigation anorectal manometry where a probe that can record pressure is placed in the anal canal. Biofeedback therapy is also a commonly used and researched therapy for fecal incontinence, but the benefits are uncertain. Biofeedback therapy varies in the way it is delivered. It is also unknown if one type has benefits over another. The aims have been described as to enhance either the rectoanal inhibitory reflex (RAIR), rectal sensitivity (by discrimination of progressively smaller volumes of a rectal balloon and promptly contracting the external anal sphincter (EAS)), or the strength and endurance of the EAS contraction. Three general types of biofeedback have been described, though they are not mutually exclusive, with many protocols combining these elements. Similarly there is variance of the length of both the individual sessions and the overall length of the training, and if home exercises are performed in addition and how. In rectal sensitivity training, a balloon is placed in the rectum, and is gradually distended until there is a sensation of rectal filling. Successively smaller volume reinflations of the balloon aim to help the person detect rectal distension at a lower threshold, giving more time to contract the EAS and prevent incontinence, or to journey to the toilet. Alternatively, in those with urge incontinence/ rectal hypersensitivity, training is aimed at teaching the person to tolerate progressively larger volumes. Strength training may involve electromyography (EMG) skin electrodes, manometric pressures, intra-anal EMG, or endoanal ultrasound. One of these measures are used to relay the muscular activity or anal canal pressure during anal sphincter exercise. Performance and progress can be monitored in this manner. Co-ordination training involves the placing of 3 balloons, in the rectum and in the upper and lower anal canal. The rectal balloon is inflated to trigger the RAIR, an event often followed by incontinence. Co-ordination training aims to teach voluntary contraction of EAS when the RAIR occurs (i.e. when there is rectal distension).
Caton 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.
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.
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.
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.
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. The Neuropsychiatric EEG-Based Assessment Aid (NEBA) System a device used to measure the Theta-to-Beta ratio was approved as a tool to assist in diagnosis of ADHD on July 15, 2013. However, the field has recently moved away from the measure. This move has been caused by the general change in the population norms in the past 20 years (most likely due to the change in the average amount of sleep in young people).
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.
Meyer and Reich discussed similar material in a British publication.
Jacobson (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.
"While Marinacci used EMG to treat neuromuscular disorders, his colleagues used the EMG only 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."
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 Rama 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 who 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 controlled exclusively 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 heart rate variability (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. The most direct effect of HRV biofeedback is on the baroreflex, a homeostatic reflex that helps control blood pressure fluctuations. When blood pressure goes up, the baroreflex makes heart rate go down. The opposite happens when blood pressure goes down. Because it takes about 5 seconds for blood pressure to change after changes in heart rate (think of different amounts of blood flowing through the same sized tube), the baroreflex produces a rhythm in heart rate with a period of about 10 seconds. Another rhythm in heart rate is caused by respiration (respiratory sinus arrhythmia), such that heart rate rises during inhalation and falls during exhalation. During HRV biofeedback, these two reflexes stimulate each other, stimulating resonance properties of the cardiovascular system caused by the inherent rhythm in the baroreflex, and thus causing very big oscillations in heart rate and large-amplitude stimulation of the baroreflex. Thus HRV biofeedback exercises the baroreflex, and strengthens it. This apparently has the effect of modulating autonomic reactivity to stimulation. Because the baroreflex is controlled through brain stem mechanisms that communicate directly with the insula and amygdala, which control emotion, HRV biofeedback also appears to modulate emotional reactivity, and to help people suffering from anxiety, stress, and depression
Emotions are intimately linked to heart health, which is linked to physical and mental health. In general, good mental and physical health are correlated with positive emotions and high heart rate variability (HRV) modulated by mostly high frequencies. High HRV has been correlated with increased executive functioning skills such as memory and reaction time. Biofeedback that increased HRV and shifted power toward HF (high-frequencies) has been shown to lower blood pressure On the other hand, LF (low-frequency) power in the heart is associated with sympathetic vagal activity, which is known to increase the risk of heart attack. LF-dominated HRV power spectra are also directly associated with higher mortality rates in healthy individuals, and among individuals with mood disorders. Anger and frustration increase the LF range of HRV. Other studies have shown anger to increase the risk of heart attack, so researchers at the Heartmath Institute have made the connection between emotions and physical health via HRV.
Because emotions have such an impact on cardiac function, which cascades to numerous other biological processes, emotional regulation techniques are able to effect practical, psychophysiological change. McCraty et al. discovered that feelings of gratitude increased HRV and moved its power spectrum toward the MF (mid-frequency) and HF (high-frequency) ranges, while decreasing LF (low-frequency) power. The Heartmath Institute's patented techniques involve engendering feelings of gratitude and happiness, focusing on the physical location of the heart, and breathing in 10-second cycles. Other techniques have been shown to improve HRV, such as strenuous aerobic exercise, and meditation.
Newton-John, Spense, and Schotte (1994) compared the effectiveness of Cognitive Behavior Therapy (CBT) and Electromyographic Biofeedback (EMG-Biofeedback) for 44 participants with chronic low back pain. Newton-John et al. (1994) split the participants into two groups, then measured the intensity of pain, the participants' perceived disability, and depression before treatment, after treatment and again six months later. Newton-John et al.(1994) found no significant differences between the group which received CBT and the group which received EMG-Biofeedback. This seems to indicate that biofeedback is as effective as CBT in chronic low back pain. Comparing the results of the groups before treatment and after treatment, indicates that EMG-Biofeedback reduced pain, disability, and depression as much as by half.
Budzynski and Stoyva (1969) showed that EMG biofeedback could reduce frontalis 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. McNulty, Gevirtz, Hubbard, and Berkoff (1994) proposed that sympathetic nervous system innervation of muscle spindles underlies trigger points.
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. A 2013 review classified biofeedback among the techniques that might be of benefit in the management of chronic migraine.
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.
Financial traders use biofeedback as a tool for regulating their level of emotional arousal in order to make better financial decisions. The technology company Philips and the Dutch bank ABN AMRO developed a biofeedback device for retail investors based on a galvanic skin response sensor. Astor et al. (2013) developed a biofeedback based serious game in which financial decision makers can learn how to effectively regulate their emotions using heart rate measurements.
A randomized study by Sutarto et al. assessed the effect of resonant breathing biofeedback (recognize and control involuntary heart rate variability) among manufacturing operators; depression, anxiety and stress significantly decreased.
A 2012 observational study by Pacella et al. found a significant improvement in both visual acuity and fixation treating patients suffering from age-related macular degeneration or macular degeneration with biofeedback treatment through MP-1 microperimeter.
Moss, LeVaque, and Hammond (2004) observed that "Biofeedback and neurofeedback seem to offer the kind of evidence-based practice that the healthcare 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 (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 joint dysfunction, 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.
The randomized trial by Dehli et al. compared if the injection of a bulking agent in the anal canal was superior to sphincter training with biofeedback to treat fecal incontinence. Both methods lead to an improvement of FI, but comparisons of St Mark's scores between the groups showed no differences in effect between treatments.
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, 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, 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:
(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 attention deficit hyperactivity disorder (ADHD), anxiety, 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.
In a healthcare 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.
The Association for Applied Psychophysiology and Biofeedback (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. The Southeast Biofeedback and Clinical Neuroscience Association (SBCNA) is a non-profit regional organization supporting biofeedback professionals with continuing education, ethics guidelines, and public awareness promoting the efficacy and safety of professional biofeedback. The SBCNA offers an Annual Conference for professional continuing education as well as promoting biofeedback as an adjunct to the allied health professions. The SBCNA was formally the North Carolina Biofeedback Society (NCBS), serving Biofeedback since the 1970s. In 2013, the NCBS reorganized as the SBCNA supporting and representing biofeedback and neurofeedback in the Southeast Region of the United States of America.
The Biofeedback Certification International Alliance (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 meeting education and training standards in biofeedback and neurofeedback and progressively recertifies those satisfying 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.
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 healthcare 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 teach them 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.
Claude Bernard 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 Wiener'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. In the first experimental demonstration of biofeedback Shearn used these procedures with heart rate. 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.
Biofeedback systems have been known in India and some other countries for millennia. 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.
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 – April: Conference on Altered States of Consciousness, Council Grove, KS; October: formation and first meeting of the Biofeedback Research Society (BRS), Surfrider Inn, Santa Monica, CA; co-founder Barbara B. Brown becomes the society's first president
1972 – Review and analysis of early biofeedback studies by D. Shearn in the 'Handbook of Psychophysiology'.
1975 – American Association of Biofeedback Clinicians founded; publication of The Biofeedback Syllabus: A Handbook for the Psychophysiologic Study of Biofeedback by Barbara B. Brown
1976 – BRS 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 and Stress and The Art of Biofeedback by Barbara B. Brown
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 – First national certification examination in biofeedback offered by the Biofeedback Certification Institute of America (BCIA); publication of Biofeedback: Clinical Applications in Behavioral Medicine by David Olton and Aaron Noonberg and Supermind: The Ultimate Energy by Barbara B. Brown
1984 – Publication of Principles and Practice of Stress Management by Woolfolk and Lehrer and Between Health and Illness: New Notions on Stress and the Nature of Well Being by Barbara B. Brown
1984 - Publication of The Biofeedback Way To Starve Stress, by Mark Golin in Prevention Magazine 1984</ref>
1987 – Publication of Biofeedback: A Practitioner's Guide by Mark Schwartz
1989 – BSA renamed the Association for Applied Psychophysiology and Biofeedback
1991 – First national certification examination in stress management offered by BCIA
1994 – Brain Wave and EMG sections established within AAPB
1995 – Society for the Study of Neuronal Regulation (SSNR) founded
1996 – Biofeedback Foundation of Europe (BFE) established
1999 – SSNR renamed the Society for Neuronal Regulation (SNR)
2002 – SNR 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 renamed the International Society for Neurofeedback and Research (ISNR)
2008 – Biofeedback Neurofeedback Alliance formed to pool the resources of the AAPB, BCIA, and ISNR on joint initiatives
2008 – Biofeedback Alliance and Nomenclature Task Force define biofeedback
2009 – The International Society for Neurofeedback & Research defines neurofeedback
2010 – Biofeedback Certification Institute of America renamed the Biofeedback Certification International Alliance (BCIA)
Christopher deCharms (of Omneuron in San Francisco) in conjunction with Stanford University School of Medicine has developed a real-time fMRI for the purpose of training the brain to activate its own endogenous opiates. deCharms believes this will revolutionize the treatment of chronic pain. The patient can control his own pain by visually looking at his rtfMRI, watching his own reactions in real time, and then blocking the pathways causing pain. deCharms mentions that clinical trials with rtfMRI is measuring a 44 to 64 percent decrease in chronic pain. With 8 participants in the study, deCharms et al.(2005) demonstrated that subjects can control the pain of heat stimulus, by visually observing in real time their brain activity. The subjects were instructed to use techniques such as changing the focus of their attention to the pain, and changing the emotional value of the pain. Then while viewing their own fMRI in real time the subjects could observe the effect of their thoughts on the part of the brain called the rostral anterior cingulate cortex (rACC). When the subject 'controlled the pain' the virtual flame on the fMRI got dimmer. Results from this study indicate two things: 1. That subjects can learn to voluntarily control brain activity in a specific region of the brain, and 2. There is a significant increase in the ability of healthy subjects to control their pain with repeated training. This study was then repeated with 8 patients with chronic intractable pain. The results showed that these patients were successful in reducing their pain rating by 64% (using the McGill Pain Questionnaire). The authors state that this is not yet a 'treatment', but still under serious investigation.
Alpha waves are neural oscillations in the frequency range of 8–12 Hz arising from the synchronous and coherent (in phase or constructive) electrical activity of thalamic pacemaker cells in humans. They are also called Berger's waves after the founder of EEG.
Alpha waves are one type of brain waves detected either by electroencephalography (EEG) or magnetoencephalography (MEG), and can be quantified using quantitative electroencephalography (qEEG). They predominantly originate from the occipital lobe during wakeful relaxation with closed eyes. Alpha waves are reduced with open eyes, drowsiness and sleep. Historically, they were thought to represent the activity of the visual cortex in an idle state. More recent papers have argued that they inhibit areas of the cortex not in use, or alternatively that they play an active role in network coordination and communication. Occipital alpha waves during periods of eyes closed are the strongest EEG brain signals.
An alpha-like variant called a mu wave can be found over the primary motor cortex.Anismus
Anismus is the failure of the normal relaxation of pelvic floor muscles during attempted defecation. It can occur in both children and adults, and in both men and women (although it is more common in women). It can be caused by physical defects or it can occur for other reasons or unknown reasons. Anismus that has a behavioral cause could be viewed as having similarities with parcopresis, or psychogenic fecal retention.
Symptoms include tenesmus (the sensation of incomplete emptying of the rectum after defecation has occurred) and constipation. Retention of stool may result in fecal loading (retention of a mass of stool of any consistency) or fecal impaction (retention of a mass of hard stool). This mass may stretch the walls of the rectum and colon, causing megarectum and/or megacolon, respectively. Liquid stool may leak around a fecal impaction, possibly causing degrees of liquid fecal incontinence. This is usually termed encopresis or soiling in children, and fecal leakage, soiling or liquid fecal incontinence in adults.
Anismus is usually treated with dietary adjustments, such as dietary fiber supplementation. It can also be treated with a type of biofeedback therapy, during which a sensor probe is inserted into the person's anal canal in order to record the pressures exerted by the pelvic floor muscles. These pressures are visually fed back to the patient via a monitor who can regain the normal coordinated movement of the muscles after a few sessions.
Some researchers have suggested that anismus is an over-diagnosed condition, since the standard investigations or digital rectal examination and anorectal manometry were shown to cause paradoxical sphincter contraction in healthy controls, who did not have constipation or incontinence. Due to the invasive and perhaps uncomfortable nature of these investigations, the pelvic floor musculature is thought to behave differently than under normal circumstances. These researchers went on to conclude that paradoxical pelvic floor contraction is a common finding in healthy people as well as in people with chronic constipation and stool incontinence, and it represents a non-specific finding or laboratory artifact related to untoward conditions during examination, and that true anismus is actually rare.Association for Applied Psychophysiology and Biofeedback
The Association for Applied Psychophysiology and Biofeedback (AAPB) was founded in 1969 as the Biofeedback Research Society (BRS). The association aims to promote understanding of biofeedback and advance the methods used in this practice. AAPB is a non-profit organization as defined in Section 501(c)(6) of the Internal Revenue Service Code.Autogenic training
Autogenic training is a desensitization-relaxation technique developed by the German psychiatrist Johannes Heinrich Schultz by which a psychophysiologically determined relaxation response is obtained. The technique was first published in 1932. Studying the self-reports of people immersed in a hypnotic state, J.H. Schultz noted that physiological changes are accompanied by certain feelings. Abbé Faria and Émile Coué are the forerunners of Schultz. The technique involves repetitions of a set of visualisations that induce a state of relaxation and is based on passive concentration of bodily perceptions (e.g., heaviness and warmth of arms, legs), which are facilitated by self-suggestions. The technique is used to alleviate many stress-induced psychosomatic disorders.Biofeedback practitioners integrate basic elements of autogenic imagery and have simplified versions of parallel techniques that are used in combination with biofeedback. This was done at the Menninger Foundation by Elmer Green, Steve Fahrio, Patricia Norris, Joe Sargent, Dale Walters and others. They incorporated the hand warming imagery of autogenic training and used it as an aid to develop thermal biofeedback.Barbara Brown (scientist)
Barbara B. Brown (1921–1999) was a research psychologist who popularized biofeedback and neurofeedback in the 1970s. "Brown was the biofeedback field's most prolific writer and most successful popularizer," said one Amazon review. Her colleagues agreed. Biofeedback Magazine, a publication of the Association for Applied Psychophysiology and Biofeedback (AAPB), noted that she was "among the first and most successful to make the public aware of the power and potential of biofeedback."Brown earned her Ph.D. in Pharmacology from the University of Cincinnati College of Medicine in 1950. She went from a technician at the William S. Merrell division of pharmaceutical company Richardson-Merrell to heading Merell's Department of Pharmacology. From there, she went to Riker Laboratories, then to Psychopharmacology Research Laboratories. Brown later became an Associate Clinical Professor of Pharmacology at the University of California, Los Angeles Center for Health Sciences and at the University of California, Irvine. She also lectured in the Department of Psychiatry at University of California, Los Angeles.Dr. Brown created and popularized the word "biofeedback." She conducted her ground-breaking research when she was Chief of Experiential Physiology Research at the Veterans Administration Hospital in Sepulveda, California.Brown was co-founder and the first president (1969-1970) of the Biofeedback Research Society, which evolved into the Biofeedback Society of America and then into AAPB. From within that organization, Brown and her colleagues helped to advance and legitimize the study of biofeedback and neurofeedback.
During the 1990s, Brown suffered a stroke; she died in 1999 at the age of 78, after living for several years after the stroke in a nursing home in Rancho Mirage, CA.Biofeedback Certification International Alliance
The Biofeedback Certification International Alliance (formerly the Biofeedback Certification Institute of America) was created in 1981 as a non-profit organization. BCIA is a member of the Institute for Credentialing Excellence (ICE). 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.BCIA has advanced this mission by developing rigorous ethical standards, Blueprints of Knowledge, core reading lists, and examinations based on the reading lists for its three main certification programs. BCIA serves the international community and the field by requiring that its certificants demonstrate entry-level competence and agree to follow its ethical code. Recertification encourages certificants to increase and update their knowledge of the field. BCIA is administered by a professional staff that is supervised by an independent board of directors of clinicians, educators, and researchers in the field.
Regionally accredited institutions in the United States and Europe have adopted the BCIA Blueprints of Knowledge. These include Alliant International University, Cal State Fullerton, East Carolina University, Forest Institute of Professional Psychology, Kansas State University, Niagara County Community College, Nova Southeastern University, San Francisco State University, Saybrook Graduate School, Sigmund Freud University (Austria), Sonoma State University, Southwest College of Naturopathic Medicine, St. Mary's University, Texas, Truman State University, the University of Maryland, the University of North Texas, the University of South Florida, and Widener University. Saybrook Graduate School and Widener University also provide distance education. BCIA has responded to growing international interest in its certification by approving new training programs in Hong Kong, Japan, and Taiwan.Professionals certified by BCIA in General Biofeedback may refer to themselves as Board Certified in Biofeedback (BCB), in Neurofeedback as Board Certified in Neurofeedback (BCN), and Pelvic Muscle Dysfunction Biofeedback as Board Certified in Biofeedback for Pelvic Muscle Dysfunction (BCB-PMD). The majority of BCIA's international certificants practice in Canada, Europe, Asia, and Australia.Cults of Unreason
Cults of Unreason is a non-fiction book on atypical belief systems, written by Christopher Riche Evans, who was a noted computer scientist and an experimental psychologist. It was first published in the UK in 1973 by Harrap and in the United States in 1974 by Farrar, Straus and Giroux, in paperback in 1975, by Delacorte Press, and in German, by Rowohlt, in 1976.Evans discusses Scientology and Dianetics, UFO religions, believers in Atlantis, biofeedback, Yoga, Eastern religions, and black boxes. He points out that these systems and groups incorporate technological advances within a theological framework, and that part of their appeal is due to the failure of modern people to find strength, comfort, and community in traditional religion and in science.In 2001 new religious movement specialist George Chryssides criticized the book's title by pointing out that most groups referred to as cults do have well-defined beliefs.Electro Physiological Feedback Xrroid
Electro Physiological Feedback Xrroid (EPFX) (), also known as Quantum Xrroid Consciousness Interface (QXCI), is a so-called energy medicine device which claims to read the body’s reactivity to various frequencies and then send back other frequencies to make changes in the body. It is manufactured and marketed by self-styled "Professor Bill Nelson," also known as Desiré Dubounet. Nelson is currently operating in Hungary, a fugitive from the US following indictment on fraud charges connected to EPFX.Descriptions of the device in mainstream media note its high price tag ($20,000 US) and the improbable nature of the claims made for it. It has reportedly been used to "treat" a variety of serious diseases including cancer. In one documented case, undiagnosed and untreated leukaemia resulted in the death of a patient.The website Quackwatch posted an analysis of the device by Stephen Barrett which concludes: "The Quantum Xrroid device is claimed to balance 'bio-energetic' forces that the scientific community does not recognize as real. It mainly reflects skin resistance (how easily low-voltage electric currents from the device pass through the skin), which is not related to the body's health."Imports to the US are now banned.Journey to Wild Divine
Journey 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. The designers refer to the product as "biofeedback software", considering it an entertaining training tool for mind and body health, rather than a "game".Management of chronic headaches
Chronic headache, or chronic daily headache (CDH), is classified as experiencing fifteen or more days with a headache per month. It is estimated that chronic headaches affect "4% to 5% of the general population". Chronic headaches consist of different sub-groups, primarily categorized as chronic tension-type headaches and chronic migraine headaches. The treatments for chronic headache are vast and varied. Medicinal and non-medicinal methods exist to help patients cope with chronic headache, because chronic headaches cannot be cured. Whether pharmacological or not, treatment plans are often created on an individual basis. Multiple sources recommend multimodal treatment, which is a combination of medicinal and non-medicinal remedies. Some treatments are controversial and are still being tested for effectiveness. Suggested treatments for chronic headaches include medication, physical therapy, acupuncture, relaxation training, and biofeedback. In addition, dietary alteration and behavioral therapy or psychological therapy are other possible treatments for chronic headaches.Mildred Gordon (Ganas)
Mildred Gordon (born 1922 - January 4, 2015) was the founder and Executive Director of the Foundation for Feedback Learning (FFL) and co-founder of the Ganas intentional community. She was the Communications Director of ActivistSolutions.org.Neal E. Miller
Neal Elgar Miller (August 3, 1909 – March 23, 2002) was an American experimental psychologist. Described as an energetic man with a variety of interests, including physics, biology and writing, Miller entered the field of psychology to pursue these. With a background training in the sciences, he was inspired by professors and leading psychologists at the time to work on various areas in behavioral psychology and physiological psychology, specifically, relating visceral responses to behavior.
Miller's career in psychology started with research on "fear as a learned drive and its role in conflict". Work in behavioral medicine led him to his most notable work on biofeedback. Over his lifetime he lectured at Yale University, Rockefeller University, and Cornell University Medical College and was one of the youngest members of Yale's Institute of Human Relations. His accomplishments led to the establishment of two awards: the New Investigator Award from the Academy of Behavioral Medicine Research and an award for distinguished lectureship from the American Psychological Association. A Review of General Psychology survey, published in 2002, ranked Miller as the eighth most cited psychologist of the 20th century.Neurofeedback
Neurofeedback (NFB), also called neurotherapy or neurobiofeedback, is a type of biofeedback that uses real-time displays of brain activity—most commonly electroencephalography (EEG)—in an attempt to teach self-regulation of brain function. Typically, sensors are placed on the scalp to measure electrical activity, with measurements displayed using video displays or sound.Photoplethysmogram
A photoplethysmogram (PPG) is an optically obtained plethysmogram that can be used to detect blood volume changes in the microvascular bed of tissue. A PPG is often obtained by using a pulse oximeter which illuminates the skin and measures changes in light absorption. A conventional pulse oximeter monitors the perfusion of blood to the dermis and subcutaneous tissue of the skin.
With each cardiac cycle the heart pumps blood to the periphery. Even though this pressure pulse is somewhat damped by the time it reaches the skin, it is enough to distend the arteries and arterioles in the subcutaneous tissue. If the pulse oximeter is attached without compressing the skin, a pressure pulse can also be seen from the venous plexus, as a small secondary peak.
The change in volume caused by the pressure pulse is detected by illuminating the skin with the light from a light-emitting diode (LED) and then measuring the amount of light either transmitted or reflected to a photodiode. Each cardiac cycle appears as a peak, as seen in the figure. Because blood flow to the skin can be modulated by multiple other physiological systems, the PPG can also be used to monitor breathing, hypovolemia, and other circulatory conditions. Additionally, the shape of the PPG waveform differs from subject to subject, and varies with the location and manner in which the pulse oximeter is attached.Prevention of migraines
Preventive (also called prophylactic) treatment of migraines can be an important component of migraine management. Such treatments can take many forms, including everything from surgery, taking certain drugs or nutritional supplements, to lifestyle alterations such as increased exercise and avoidance of migraine triggers.
The goals of preventive therapy are to reduce the frequency, painfulness, and/or duration of migraines, and to increase the effectiveness of abortive therapy. Another reason to pursue these goals is to avoid medication overuse headache (MOH), otherwise known as rebound headache, which is a common problem among migraineurs. This is believed to occur in part due to overuse of pain medications, and can result in chronic daily headache.Standards for the conducts of trials of preventive medications have been proposed by the Task Force of the International Headache Society Clinical Trials Subcommittee.Synkinesis
Synkinesis is the result from miswiring of nerves after trauma. This result is manifested through involuntary muscular movements accompanying voluntary movements. For example, voluntary smiling will induce an involuntary contraction of the eye muscles causing the eye to squint when smiling. Most commonly involved are facial muscles and the extraocular muscles, rarely the hands are performing mirror movements.
Causes are diverse and include nerve trauma with improper healing, or nerve degeneration, as in the course of Parkinson´s disease. In congenital cases, mutations of genes involved in nerve growth, specifically axonal growth have been found. Rarely, it is part of syndromes with neuroendocrine problems such as Kallman syndrome.The prognosis is usually good with normal intelligence and lifespan. Treatment depends on the cause, but is largely conservative with facial retraining or mime therapy, if needed, while Botox and surgery are used as last resort.Thomas Budzynski
Thomas Hice Budzynski (October 13, 1933 – February 14, 2011) was an American psychologist and a pioneer in the field of biofeedback, inventing one of the first electromyographic biofeedback training systems in the mid-1960s. In the early 1970s, he developed the Twilight Learner in collaboration with John Picchiottino. The Twilight Learner was one of the first neurotherapy systems.
Budzynski earned a BSEE at the University of Detroit and served as an aerospace inertial systems engineer on the SR-71 Blackbird project at Area 51. He later received a master's and a PhD in psychology.
Budzynski was a licensed psychologist in the State of Washington. He was an Affiliate Professor at the University of Washington in Seattle, where he also conducted neurotechnology research with his wife, Helen Kogan Budzynski. He conducted studies on the effects of audio-visual stimulation on the brain; the priming effects of binaural tones as measured by the EEG; chronic fatigue syndrome; and applications for chronic pain, enhanced academic performance, and the enhancement of cognitive processes in individuals with head injuries, learning disorders, and the elderly.
Budzynski's research and clinical findings were published in professional journals including: the Journal of Applied Behavioral Analysis; Experimental & Clinical Psychopharmacology; the Journal of Behavior Therapy and Experimental Psychiatry; Biofeedback and Self-Control; Biofeedback: Behavioral Medicine; Psychosomatic Medicine; the Journal of Dental Research; Biofeedback and Self-Regulation; Consciousness and Self-Regulation; Psychology Today; Somatics; Education; the Journal of Neurotherapy; Applied Neurophysiology and Brainwave Biofeedback; Clinical Neurophysiology; and NeuroImage.
Budzynski gave lectures at conferences, including several Annual Meetings of the Biofeedback Research Society; Annual Meetings of the American Psychological Association; Annual Meetings of the Association for Applied Psychophysiology and Biofeedback; Stanford University; University of Washington; Oxford University; the University of Munich; and the University of Düsseldorf, Germany.
Budzynski developed a series of Life Management subliminal and priming  recordings. Applying his research on brainwave activity, he created peak performance tools utilizing research and theory on brain lateralization, lateralized emotions, dual track brain messaging, binaural beats, and priming. These techniques are used in coping with psychological stress and anxiety, as well as enhancing memory, self-confidence, self-esteem and relaxation.
He maintained a private practice of neurofeedback,biofeedback, and psychotherapy in his clinic in Poulsbo, Washington.
Budzynski died suddenly of a heart attack on February 14, 2011.Trendelenburg gait
The Trendelenburg gait is an abnormal gait (as with walking) caused by weakness of the abductor muscles of the lower limb, gluteus medius and gluteus minimus. People with a lesion of superior gluteal nerve have weakness of abducting the thigh at the hip.
This type of gait may also be seen in L5 radiculopathy and after poliomyelitis, but is then usually seen in combination with foot drop.
During the stance phase, the weakened abductor muscles allow the pelvis to tilt down on the opposite side. To compensate, the trunk lurches to the weakened side to attempt to maintain a level pelvis throughout the gait cycle. The pelvis sags on the opposite side of the lesioned superior gluteal nerve.
This gait is precipitated by strain to the gluteus maximus and gluteus minimus.
This gait may be caused by cleidocranial dysostosis.
Biofeedback and physical therapy have been used in treatment.When the hip abductor muscles (gluteus medius and minimus) are weak, the stabilizing effect of these muscles during gait is lost.
When standing on the right leg, if the left hip drops, it's a positive right Trendelenburg sign (the contralateral side drops because the ipsilateral hip abductors do not stabilize the pelvis to prevent the droop).
"When the patient walks, if he swings his body to the right to compensate for left hip drop, he will present with a compensated Trendelenburg gait; the patient exhibits an excessive lateral lean in which the thorax is thrust laterally to keep the center of gravity over the stance leg."Urinary incontinence
Urinary incontinence (UI), also known as involuntary urination, is any uncontrolled leakage of urine. It is a common and distressing problem, which may have a large impact on quality of life. It has been identified as an important issue in geriatric health care. The term enuresis is often used to refer to urinary incontinence primarily in children, such as nocturnal enuresis (bed wetting).Pelvic surgery, pregnancy, childbirth, and menopause are major risk factors. Urinary incontinence is often a result of an underlying medical condition but is under-reported to medical practitioners. There are four main types of incontinence:
Urge incontinence due to an overactive bladder
Stress incontinence due to poor closure of the bladder
Overflow incontinence due to either poor bladder contraction or blockage of the urethra
Functional incontinence due to medications or health problems making it difficult to reach the bathroomTreatments include pelvic floor muscle training, bladder training, surgery, and electrical stimulation. Behavioral therapy generally works better than medication for stress and urge incontinence. The benefit of medications is small and long term safety is unclear. Urinary incontinence is more common in older women.