Anxiety, Phobias & Panic Attacks
(Some Material Adopted from the AAPB White Papers)


Clinical biofeedback training is an extremely valuable tool in combating emotional and physiological arousal resulting from anxiety, panic, and phobias. Anxiety Disorders according to the DSM - IV are the most frequently occurring emotional disorder in the United States. Anxiety Disorders according to the DSM - IV categorizing system include not only Phobias and Panic Attacks, but Obsessive-Compulsive Disorder, Acute Stress Disorder, Posttraumatic Stress Disorder and Generalized Anxiety Disorder. Biofeedback teaches an individual skills and techniques to combat these disorders.

Anxiety is familiar to all of us and means a chronic persistent sense of uneasiness or dread, usually coupled with significant changes in physiology, and frequently accompanied by avoidance behavior or dissociation to some degree. Some anxiety is situation based or focused on particular events or objects (phobia); other anxieties may be reflected by a particular pattern of thoughts or actions (obsessions), or may be rooted in a past event that to some degree was experienced as overwhelming (acute stress response and post traumatic stress). Panic tends to be more physiologically entwined and may appear with or without fear of public places (agoraphobia). The most common "disorder" is Generalized Anxiety Disorder. The essential feature of this last disorder is a pervasive tension or apprehension with no distinguishable stressor ("free floating anxiety").

Symptoms of Anxiety

Some of the array of symptoms of the Anxiety Disorders would include significant increase in skeletal muscle tension that might include trembling, twitching, shakiness, and week legs. Feelings of numbness or paresthesias in the extremities are common along with muscle soreness, aches and pains, feelings of restlessness, and being easily fatigued. Some of the symptoms of autonomic hyperactivity might include rapid heart beat, elevated blood pressure, palpitations, shortness of breath, dizziness, dry mouth, nausea, diarrhea and gastrointestinal upset, flushes or chills, cold and clammy hands, increased sweating response, frequent urination, difficulty swallowing or a sense of "a lump in the throat", and rapid or pressured speech. Symptoms of vigilance and scanning my include feeling keyed up and on edge, an exaggerated startle response, difficulty concentrating, the mind "going blank", difficulty falling or staying asleep, and irritability and a lowered threshold to anger.

Treatment and Biofeedback

Treatment for Anxiety Disorders may include a check up with your physician to rule out any organic or pathological diseases, medication, and behavioral techniques and training. Behavioral treatment offers an alternative or an adjunct to medication. Biofeedback training is a part of the behavioral treatment plan because it offers a non-pharmacological approach to direct symptom reduction. Each of us responds to stressors and anxiety with our own particular pattern and pathway, albeit with similarities to others. Biofeedback can be used in a style or manner specific to the individual's psychophysiological profile. For some individuals the sweat activity (electrodermal) of the palmer surface of the hands is a modality of choice in learning skills of anxiety reduction. For others learning some vascular control via heart rate modulation and increasing peripheral blood flow (warming the hands) is a good strategy. For others, muscle tension or perhaps, brainwave training to develop skills at quieting the mind in a matter of minutes or even seconds may be the tool of choice.

In my therapy and training approach, I initially look at the client's skill at general mental and physiological quieting on all aspects of physiology that we commonly monitor in biofeedback. In my work and in the published work of other clinicians, significant skill mastery and symptom reduction can occur in six to twelve sessions, with more chronic and complex problems requiring more. Biofeedback is most effective with clients who are willing to practice and take some active role in the treatment and training process.

With specific phobias, I will often work with the client to construct a hierarchy from least to most anxiety provoking stimuli or events. We will train in the office to gain command of physiological quieting and negative thought stopping and then take it out into the "field", so called "in vivo" training when the client is ready to do so. Many have conquered situations that they had lost all hope of being able to do. Biofeedback is a tool and an ally in winning the battle against Anxiety Disorders.

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