Clinical Biofeedback

What is Biofeedback?

It is a tool and a technique for the learning of skills of self-regulation or control of so called involuntary and voluntary processes of the mind and body. The learning is accomplished via precise, immediate and meaningful auditory and/or visual feedback of key aspects of an individual's physiology. The learning is accelerated and enhanced by the use of auxiliary techniques such as Autogenic Training, Progressive Relaxation, Systematic Desensitization, diaphragmatic breathing, by practice with and without instruments, and by the expert guidance, coaching and teaching of a trained and skilled therapist. Biofeedback is used to increase relaxation, relieve pain and the effects of stress and is used to train awareness and mindfulness for the promotion of healthier and more comfortable life patterns.

Two Basic Mind/Body laws:

(1) Any change in our physical state results in a change in our mental/emotional state; any change in our mental/emotional state results in a concomitant change in our physical state.
(2) Any physiological processes that can be monitored and fedback in a meaningful way can be controlled.

Commonly Used Modalities:

Quality biofeedback can be done with small "stand alone" instruments that offer one or sometimes two training modalities. Biofeedback can be done in a group format but only a few practitioners have the expertise and equipment to provide this service. Dr. Barton has been offering group biofeedback for over 20 years.
Computerized biofeedback has recently gotten very good and today is
the standard that clinicians use. Dr. Barton trains with the BioIntegrator; perhaps the top computerized system for clinical work available. Multiple modalities are trained with simultaneously and feedback is presented visually and auditorily in a meaningful and spectacular way.

EMG = Electromyography; this consists of the surface monitoring of voluntary (or striate) muscle activity and is measured in microvolts. A clinician can reliably assess what is clinically elevated activity and establish treatment goals. More tension equals more microvolts of muscle activity.

EDR = Electrodermal Response (classically called the galvanic skin response); this is generally surface sweat gland activity (eccrine glands) in the hands and is considered an analog of arousal or sympathetic reactivity (excitability); the units of measurement are micromhos (units of skin conductance); higher means more activated and sweatier palms. Conversely, kilohms (resistance) can be the unit of measure with a typical goal in training of between 800 and 1200 kilohms.

Temperature = Surface hand temperature is one indicator of how relaxed or stressed and individual is. It is a cornerstone skill of learning self-regulation. Generally, warmer hands indicate a quieter and more relaxed mind/body state. A balanced temperature between right and left hands in the range of 93 and 96 degrees Fahrenheit would be a typical training goal.

Heart Rate = Beats per minute along with the wave form and beat to beat variability can be a powerful training modality for self regulation that may be very important to certain disorders. Breathing patterns and proper breath technique can have a profound effect on the rate and waveform. Heart rate goals are typically between 52 and 64 while respiration rate at 6 to 10 breaths per minute. HR is measured with a photoplethysmograph.

EEG = Electroencephalogram or brainwave feedback is a modality that only a small percentage of biofeedback clinicians are competent in.
Quality EEG feedback calls for sophisticated equipment. There are four main frequency bands (beta, alpha, theta and delta) that are associated with specific states of consciousness and attention. This feedback is being used for ADD work, epilepsy, insomnia, anxiety, chronic pain, peak performance, creativity enhancement and other states of consciousness training.

When Did Biofeedback Begin?

1969: Several researchers and clinicians contributed: Neal Miller at Rockefeller University, Elmer Green at the Menninger Clinic, Joe Kamiya at the Univ. of Chicago, Barbara Brown @ UCLA, Thomas Basmajian and others. Dr. Arthur Gladman, his assistant, Norma Estrada, Ken Pelletier, Ph.D., and Erik Peper, Ph.D. were all instrumental in bringing biofeedback to the Bay Area in the early 1970ies. Dr. Barton trained with all of them and
began doing biofeedback group work and individual work in 1975.

What Conditions Are Commonly Treated With Clinical Biofeedback?

The most common "physical" conditions that biofeedback has shown considerable efficacy with are: muscle contraction headaches (tension headaches), vascular headaches (migraines), essential hypertension, Raynaud's Disease, tempomandibular and facial pain, and chronic pain management. It is quite useful with sufferers of tinnitus, fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome, and some types of insomnia particularly problems with sleep onset. It is being used as a corner-stone in the treatment of neuromuscular re-education, musculoskeletal therapy, and gait training where function has been lost (typically administered by qualified physical therapists).

A wide range of mental and emotional illnesses can benefit from the practice of biofeedback including the anxiety disorders, phobia's and panic disorders, hypomania, acute stress disorder and Post Traumatic Stress Disorder. It can be an important tool in habit control and in combating chemical dependency.

There are "new" frontiers that biofeedback is showing impressive results with including incontinence training with both surface myography feedback (EMG) as well as in vitro using vaginal and anorectal probes.

EEG or brainwave feedback is being used with Seizure control, ADD (Attention Deficit) treatment with good results (although the training protocol is typically quite long). EEG is useful for the learning of states of consciousness training, mental quieting, and attention or focusing training.

Therapy Goals: Symptom understanding, improvement and or elimination; Becoming an active participant in ones healing and improving the quality of ones life; positive attitude enhancement as one takes more control of their health. Goals for specific syndromes or afflictions often include specific, concrete and measurable physiological markers.

Length, Number, and Frequency of Sessions:

The symptoms, morbidity and chronicity of the problem all effect length of treatment. Sessions typically are 45 to 50 minutes. I will often see out-of-town patients for 90 minutes initially and then 50 minutes thereafter. Some very effective work can be done in the short term (4 to 8 sessions) with such conditions as muscle contraction headaches, myositis and facial pain. I have clients rent and practice with home training instruments to involve the client in treatment, to gain compliance, and to accelerate progress. Typically 12 to 20 sessions will provide an opportunity for true self regulation learning, some degree of mastery, and some degree of integration of the skill into ones on-going life.

Requirements of Profession: Training and Certification:

Practitioners may only practice in their qualified areas of expertise, training, and licensure. The Biofeedback Certification Institute of America (BCIA) is the standard bearer of qualified practitioners. Dr. Barton is a Senior Fellow of the BCIA, #387, is certified with the Biofeedback Society of California (BSC), #253, and is twice a past president of the BSC. He is licensed in California as a Marriage and Family Therapist, #16735, since 1982.

Most Often Asked Questions in First Time Visits:

Clients want to know fairly quickly if they are "normal" or not. With each physiological channel norms will be explained. Despite unique individual differences therapy or training has common, identifiable goals.

Treatment goals and how long "treatment" will take are also early concerns. If I am unable to answer these fully in the first session, I will often ask the individual to suspend any judgements until we have completed four sessions. At that time we will re-evaluate where we are going, treatment goals and progress and whether this tool and this therapist is right for them.

While clients learn the skills in the office, the question is whether they will be able to "integrate" the skill and be able to use it outside of the office. The integration of the skills learned into ones on-going life is the ultimate goal and does require a willingness and motivation to practice outside of the office visits. Changing deep-seated behavior patterns can be done and sometimes takes considerable time and attention.

Biofeedback will not interfere with other treatment that you may be receiving and is usually complementary. Medication usage and reliance may, oftentimes, be reduced as a person gains self-regulation mastery.

William G. Barton, Ph.D., MFCC
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