Biofeedback: helping people gain control of their health - Research Update

Parks & Recreation, Dec, 2001 by Carmen V. Russoniello

We have not been informed that our bodies tend to do what they are told if we know how to tell them.

-- Elmer Green

A Pioneer in Biofeedback

The purpose of this research update is to apprise recreational professionals of the many uses for measuring and monitoring individual physiological changes and then feeding these signals back to the person who learns how to control them. This technique, known as biofeedback, has both clinical and non-clinical applications, and can be an important tool for recreation professionals seeking to quantify an individual's reactions to internal and external stimuli. Applications for biofeedback include the assessment of a person's responses to recreational experiences (e.g. marketing information gleaned from measuring physiological responses of individuals to park experiences) or feeding back the signals to patients who learn how to control pain, and decrease symptoms of insomnia, ADD/ADHD, depression, and anxiety. In addition, biofeedback is now used to predict mortality (Huikuri, et al, 1998), to measure multiple physiological variables during space flight (Friend, 2001), and to shape appropriate behaviors (Schwartz, 1995). The number of biofeedback applications grows daily.

Most of what is known about biofeedback is the result of medical studies where individuals have been taught to self-regulate their bodies by consciously altering physiological processes using signals that are fed back to them (Robbins, 2000). According to the National Institutes of Health (1999), biofeedback "is a treatment technique in which people are trained to improve their health by using signals from their own bodies" (p. 1). The word biofeedback became popularized in the 1960's when laboratory researchers were studying the potential of individuals to alter blood pressure, heart rate, and other "involuntary" bodily functions (NIMH, 1999). In 1969, a group of scientists met in California to discuss this emerging field and decided to use the term biofeedback to describe "the use of appropriate instrumentation to bring covert physiologic processes to the conscious awareness of one or more individuals" (Association for Applied Psychophysiology and Biofeedback, 1992, p. 2). Simply put, therapists, with the aid of instrumentation that feeds back physiological signals, utilize activities such as relaxation, imagery, computer games, and recreational activity to assist people in gaining control over inappropriate physiological responses which, if left unchecked, can cause or exacerbate illness and other dysfunctions. Biofeedback therapists use the principles of "classic conditioning" and "shaping" to assist clients with the identification and control of inappropriate physiological responses. For example, a child who has ADD/ADHD could be treated using EEG (electroencephalography) biofeedback by placing sensors on the scalp that pick up electrical impulses and then feeding these signals back to the child, who soon learns how to control them (Lubar, 1995). The child works at decreasing the electrical (brain wave) activity associated with ADHD and increasing those associated with a more relaxed state. In essence, the child would "condition" themselves toward more appropriate responses as they play a video game that requires the appropriate physiological responses to win. As the child succeeds at one level the "threshold" or short-term objective is raised, and shaping continues until the person reaches the end goal of increased attention and decreased hyperactivity.

The measurement of physiological signals using biofeedback instrumentation is evolving concomitant to technology, and now includes very sensitive measuring and monitoring sensors. Most modern computers are capable of processing and displaying biofeedback signals. Laptops offer portability and the subsequent advantages. Typical modalities used by biofeedback therapists include: Electromyography (EMG), for muscle re-education and relaxation; Skin Temperature (thermal biofeedback), used for treating cardiovascular (hypertension, migraine, and Raynaud's Disease) and cardio-respiratory disorders (asthma); Electrodermal Response (EDR), sometimes referred to as Galvanized Skin Response (GSR), is used in the treatment of anxiety and depression or to test an individual's fidelity (polygraph); and Electroencephalography (EEG), with indications that include the treatment of addictions, ADD/ADHD, and many emotional and cognitive disorders (AAPB, 1992). EEG is a rapidly growing separate field of biofeedback which calls for specialized certification. Finally, heart rate variability, a finite measurement of sympathetic/parasympathetic modulation of the heart, is now considered a marker for relaxation, good health, cardiovascular disease and depression (Mussleman, Evans, & Nemeroff, 1998), and mortality (Tsuji et al., 1994; Huikuri et al., 1998). In one sense the heart does indeed "think," or react to stimuli such as stress, by varying the rate and intensity of its response. Some responses are sympathetically driven and some parasympathetically driven. Harmony between the systems is sought after, and decreased heart rate variability is associated with a variety of pathological conditions as noted above.