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Biofeedback therapy is a non-drug treatment in which patients learn to control bodily processes that are normally involuntary, such as muscle tension, blood pressure, or heart rate.
While more evidence is needed to support its effectiveness in some disorders, it is believed to help in a range of conditions, such as chronic pain, urinary incontinence, high blood pressure, tension headache, and migraine headache.
As it is noninvasive and does not involve drugs, the potential for risk or undesirable side effects is reduced, which could make it suitable for those who wish to avoid medications, or those who cannot use them, such as pregnant women.
It is often combined with relaxation training.
In biofeedback therapy, electrodes attached to the patient provide information about physiological processes.
There are three common types of biofeedback therapy:
Thermal biofeedback measures skin temperature
Electromyography measures muscle tension
Neurofeedback, or EEG biofeedback
EEG biofeedback is a specialized type of biofeedback that measures brain wave activity. It may help patients with attention deficit hyperactivity disorder (ADHD), addiction, anxiety, seizures, depression, and other types of brain condition.
During a biofeedback session, the therapist attaches electrodes to the patient's skin, and these send information to a monitoring box. The therapist views the measurements on the monitor, and, through trial and error, identifies a range of mental activities and relaxation techniques that can help regulate the patient's bodily processes.
Eventually, patients learn how to control these processes without needing to be monitored.
Sessions typically last less than one hour. For some conditions, patients experience relief within in eight to 10 sessions. For other conditions, such as high blood pressure, improvements may take 20 sessions to appear. The sessions will be supplemented with mental and relaxation activities to be completed at home for 5 to 10 minutes a day.
It remains unclear why or how biofeedback works, but it appears to benefit people with conditions related to stress, according to The University of Maryland Medical Center (UMM).
When a person is stressed, their internal processes such as blood pressure can become irregular. Biofeedback therapy teaches relaxation and mental exercises that can alleviate symptoms.
Biofeedback and relaxation techniques are commonly sought as a treatment for headaches and migraine, but studies into its effectiveness have produced mixed results.
In 2015, a Japanese study found that biofeedback therapy reduced the frequency and severity of symptoms in people with migraine headaches.
However, in 2009, another group reported that while relaxation appears to benefit people with migraine headaches, combining relaxation with biofeedback does not seem to produce additional benefits.
The authors note:
"Biofeedback is an extremely costly and time-consuming treatment modality that, in our study, provided no additional benefit when compared to simple relaxation techniques alone, in the treatment of migraine and tension-type headaches in adults."
The Michigan Headache and Neurological Institute (MHNI) suggests that biofeedback therapy improves symptoms of headache and migraine in 40 to 60 percent of patients, similar to the success rate of medications.
They suggest that combining biofeedback with medication may increase the effectiveness of both, but that while biofeedback may help relieve stress-induced migraine, cases stemming from other triggers may be less responsive.
Neurofeedback is a kind of feedback therapy that may help patients with ADHD.
Some studies have suggested that EEG biofeedback, or neurofeedback, may help people with ADHD.
According to authors of a systematic review published in The BMJ in 2014, growing evidence indicates that neurofeedback could help with ADHD, but they call for further investigations to confirm its effectiveness, because of the weak design of many studies.
Post-traumatic stress disorder
Some types of biofeedback therapy may help patients with post-traumatic stress disorder (PTSD).
One study found that adding heart-variability biofeedback to standard PTSD treatment did not bringany benefit.
However, in 2016, scientists reported that the use of EEG biofeedback "significantly reduced PTSD symptoms" in 17 patients with PTSD
The Agency for Health Care Policy and Research currently recommends pelvic floor muscle training with biofeedback therapy for the treatment of urinary incontinence, based on findings in clinical studies.
Children's anxiety at the dentist's
Researchers at the Narayana Dental College and Hospital in India examined whether biofeedback therapy might help control children's anxiety when receiving dental restorations.
In the journal European Archives of Paediatric Dentistry, they conclude that "Biofeedback can be used in the initial visits for dentally anxious children and the usage of simpler biofeedback machines for these appointments in dental setup is suggested."
Raynaud's disease is a condition that causes some parts of the body to feel numb and cool in response to cold temperatures or emotional stress. It is caused by a problem of blood supply to the skin.
Studies indicate that thermal biofeedback can help alleviate symptoms of Raynaud's disease. The Raynaud's Association reports that 80 to 90 percent of patients with Raynaud's experienced improved circulation and a reduced frequency of symptoms after therapy.
A team from the University of Iowa found that biofeedback treatment showed better results that the use of laxatives for chronic constipation, and that biofeedback can successfully retrain the muscles that cause chronic constipation.
According to the lead author of the study, "results show that bowel movement improvement is possible in nearly 80 percent of patients through biofeedback."
This was supported by researchers in 2014, who concluded that patients with constipation, either with and without irritable bowel syndrome IBS "will likely benefit from biofeedback therapy."
Scientists at the University of Lübeck in Germany found that electrical stimulation combined with biofeedback therapy helped patients with fecal incontinence.
They reported in the International Journal of Colorectal Disease that "there is sufficient evidence for the efficacy of BF (biofeedback) plus ES (electrical stimulation) combined in treating fecal incontinence. AM-MF (Amplitude-modulated medium-frequency) stimulation plus BF seems to be the most effective and safe treatment."
Cognitive and behavioral therapies
Dr. John Krystal, Editor of Biological Psychiatry, said biofeedback may open new avenues for cognitive and behavioral therapies.
He was commenting on a study in which people were able to control the activity of certain regions of the brain when they receive feedback signals by functional magnetic resonance brain imaging (fMRI).
Chronic rectal pain
Studies by researchers at the University of North Carolina have shown that biofeedback is more effective than some other treatments for a type of chronic rectal pain called levator ani syndrome.
Nocturnal bruxism is the clenching, bracing, grinding or gnashing of the teeth and jaws during sleep.
A team at The Turner Dental Hospital, Manchester, in the United Kingdom, investigated the effect of biofeedback therapy on this condition.
Nineteen participants were given a special biofeedback device, and they were instructed to wear it every night for 5 weeks.
Eleven of the participants experienced a reduction in headaches and jaw-muscle discomfort on waking up in the morning.
The study authors concluded: "The use of biofeedback could reduce the level of parafunctional activity and bring about meaningful symptomatic improvement." They added that no adverse effects were observed during the study period.
Persisting childhood apraxia of speech
A person with apraxia of speech finds it hard to say what they want to say correctly and consistently. It is due to a problem in the brain, not the speech muscles.
Researchers at Haskins Laboratories in Connecticut looked at the effectiveness of a treatment program that included ultrasound biofeedback for six children with childhood apraxia of speech (CAS), who had persisting speech sound errors.
After 18 treatment sessions, the authors concluded that "a treatment program including ultrasound biofeedback is a viable option for improving speech sound accuracy in children with persisting errors associated with CAS."
Other conditions that may benefit from biofeedback include:
High blood pressure
Biofeedback therapy can help to optimize performance in sports participants.