Biofeedback: The New Way to Treat Anxiety

While it was a very uncommon therapy 25 years ago, biofeedback is rapidly emerging into the mainstream, being taken up by more and more professionals and being granted coverage by Medicare and many health insurers for a range of conditions.

While applied psychophysiology is still in its “testing”phase, and not all the benefits of learning and applying self-regulatory skills have proven as profound as was hoped for and predicted by some, a sufficient body of research (and related clinical data) does support biofeedback being used in a substantial secondary role when it comes to treating myriad disorders. As new research emerges, more and more possible applications for this therapy are being imagined and tested.

The term “biofeedback”(or psychophysiological feedback), is used to describe the process of electronically monitoring involuntary or sub-threshold physiological processes, then influencing these processes via intentional changes in cognition, in an attempt to utilize the mind-body connection to its fullest advantage. Biofeedback provides a medication-free form of therapy that allows one to influence one’s own health through the power of the mind.

This process begins in a quiet room, where the patient (hooked up to various sensors) relaxes in a comfortable chair while viewing a monitor that displays multiple processes that are ongoing in his or her own body. Visual and auditory feedback is then employed to reinforce the patient attaining the desired physiological states as set out by his or her specific treatment program. Various data can be collected and stored as part of monitoring the patient’s treatment over the long term.

Biofeedback: The New Way to Treat AnxietyDifferent kinds of feedback modalities include:

Electromyographic (EMG): When collecting this kind of feedback, the frontalis, masseter, trapezius and sternocleidomastoid are monitored electronically.

Skin Conductance Level (SCL): AKA the Galvanic Skin Response (GSR). Finger electrodes sense and record sweat gland activity.

Thermal: Finger thermistors study and record the patient’s levels of vasoconstriction by monitoring small alterations in peripheral blood flow.

Respiratory: Strain gauges are used to assess the patient’s abdominal and thoracic excursions while a capnometer keeps track of all exhaled CO2.

Heart Rate (HR): Finger photoplethysmography is used to measure the patient’s heart rate and pulse volume.

Brainwave/Neurofeedback (EEG): Today, multichannel equipment running sophisticated software is used along with new treatment protocols, replacing the now-outdated single channel alpha training.


Biofeedback: Treatment Applications


Biofeedback ranks well for use in relaxation therapy, matching the effectiveness of hypnosis, progressive muscle relaxation, and transcendental meditation. Biofeedback, however, is seldom used alone, and is often employed as a complementary therapy to be used in conjunction with other therapies.

Biofeedback has a noteworthy range of psychiatric applications, having been found to be effective in treating the psychological disorders of anxiety and insomnia particularly, when used in conjunction with other therapies such as dynamic, behavioral, and brief therapies.

Patient and therapist alike benefit from being able to monitor the patient’s various physiological responses, as these can signify states like resistance, denial, and other defense mechanisms. Biofeedback monitoring therefore can be seen as a visible linking system, linking the patient’s thoughts and feelings through physical response mapping.

Brain wave feedback has shown notably efficacy in the treatment of attention-deficit/hyperactivity disorder (ADHD), problems related to addiction, and post-traumatic stress disorder (PTSD).


Biofeedback and Treating Generalized Anxiety Disorder (GAD)


Anxiety is something of a modern epidemic, being one of the foremost emotional disorders that are seen by the vast majority of psychiatrists practicing today. Anxiety disorders are marked by having the dual characteristics of physiologic hyperarousal and inexplicable, irrational, and intense emotional fear.

Biofeedback has been shown to help lessen the symptoms of generalized anxiety disorder (GAD) and aid in exposure desensitization therapy (commonly used in treating panic disorder [PD] and PTSD).

As part of multimodal cognitive/behavioral therapy (CBT), biofeedback can offer patients a safe and effective alternative to medications, which is particularly useful for patients with medication sensitivities or those who may become dependent on them (though medication in addition to CBT and biofeedback is still considered the optimal course of treatment by most professionals).

Biofeedback may enhance the therapeutic effectiveness of a range of therapy techniques, such as desensitization, modelling, or flooding, and in assisting the cognitive interventions used to identify negative thinking and reshape it into a more realistic assessment of the patient’s life events.

CBT and Biofeedback for use in Treating Panic Disorder

Research into Panic Disorder (PD) suggests that panics become ongoing in patients owing to a fear of bodily sensations that has developed as the patients associate said sensations with panic attacks. This extreme vigilance creates anxiety and, ironically, leads to a frequent recurrence of panic attacks.

Biofeedback is useful in PD treatment because low arousal relaxation training, a part of PD therapy, may itself lead to panics due to inducing increased awareness in the patient, and biofeedback has been shown effective in preventing this risk factor. It is also useful in the diagnostic process, as it can be used to monitor physiological reactions to the therapist’s questions about anxiety. To achieve this, the patient’s EMG, SCL, HR, temperature, and respiration are measured as questions are asked.

Biofeedback has been shown to increase the efficacy of all four forms of CBT which are used at present to treat PD. These are defined as follows:

Educational, Informational: Patients are educated about the causes of panic, and shown the cycle they have gotten into, in which they essentially fear their fear itself (by fearing the occurrence of panic attacks). Biofeedback is used here to help the patient understand the relationship that exists between the patient’s thoughts, feelings, visual perceptions, bodily sensations, and his or her body’s responses. Biofeedback has been shown to greatly expedite this part of the patient’s learning process.

Somatic Management Strategies: Here diaphragmatic breathing retraining, slow breathing, and muscle relaxation is used to control the patient’s levels of apprehension and chronic low-level anxiety. Biofeedback has been shown to aid greatly in patient confidence by allowing him to her to actually see the effect his or her efforts are having on the body, leading to a feeling of mastery and control which directly counteracts the helpless mentality of being a victim to panic.

Cognitive Restructuring: During this portion of therapy, the patient learns how to use positive “self-talk” to reduce his or her fear of anxiety sensations. This eventually leads to the patient developing more realistic attitudes towards his or her symptoms and the possible outcomes of panic. Here biofeedback is used to show patients the difference in how their bodies react after they have restructured their thoughts effectively.

Fear Exposure Strategies: In this final step, fear exposure is used to limit panic itself; this therapy is widely known for its extreme usefulness in treating specific phobias and obsessive-compulsive disorder. The patient is intentionally exposed to what he or she fears during this therapy, so as to break the link between the subject of that fear and a panic reaction. This may be done in a brief and graduated way (spaced with intervals of relaxation) until the patient has learned to relax around the subject of fear, or in a prolonged and intense way known as “flooding.”During flooding, the patient must experience the subject of fear for up to 15 minutes at a time (often while using various breathing techniques to cope with the panic), time in which he or she is made to realize no negative consequences actually occur.

Patients and therapists both benefit from immediate autonomic feedback in guiding the aforementioned processes. Biofeedback-assisted CBT for PD leads to an increased awareness of the patient’s stress response (subsequently used to create control over it), increased patient motivation (as motivation can be driven by visible results), and increased patient confidence and feelings of mastery, a core element of the patient breaking free of the “panic mindset”in a longterm way.

Biofeedback for Treating Anxiety in Children

More than one controlled study has now demonstrated the benefits of using biofeedback to reduce anxiety in children. In 1996, Wenck et al. studied 150 7th-8th graders who had been said to be “anxious”by their teachers. Some of the students were randomly selected to receive six sessions each of EMG and thermal biofeedback (with others forming control groups). The researchers found that the biofeedback group had the lowest levels of anxiety at the cessation of the study, out of all the groups of students.

Referrals and Certification

Biofeedback therapy is usually performed by clinical psychologists, who may also use a “biofeedback trainer”under strict supervision. The Biofeedback Certification Institute of America has set out a certification process that involves both written and practical study. The Association for Applied Psychophysiology and Biofeedback in Wheat Ridge, Colo., sponsors an annual conference and gives out information to prospective patients, along with referrals. Some states also have biofeedback societies through which one can attain a local referral.

Tagged , , , , , , , . Bookmark the permalink.

Comments are closed.