What is Biofeedback?
Biofeedback is an umbrella term for various types of treatments that teach psychophysiological self-regulation. There are many different forms of biofeedback, including electromyography (EMG), temperature, heart-rate variability (HRV), and electrodermal response (EDR). There are all forms of peripheral (i.e., body) biofeedback. One the principles of biofeedback is that there is reciprocal relationship between the brain and body. This means that not only does the brain control the body, but the body controls the brain. The brain constantly monitors the body for changes. Biofeedback is also grounded in the behavioral sciences. Biofeedback is based on a principle known as “operant conditioning,” specifically positive reinforcement. Research has shown positive reinforcement increases the likelihood of a behavior and when a behavior is reinforced repeatedly and consistently over time, the behavior can be learned and retained. This is why the biofeedback treatment gains typically endure even after treatment ends.

A primary target of peripheral biofeedback is the human autonomic nervous system, particularly the sympathetic nervous system (“fight or flight” system). The sympathetic nervous system is involved in most forms of anxiety, and those who are chronically anxious will often show excessive sympathetic nervous system activity, such as tacycardia, hypertension, etc. In fact, temperature-, HRV-, and EDR-biofeedback are really just different ways to train the autonomic nervous system. The autonomic nervous system received its name because many years ago it was believed that this system operated outside of our control (“automatic”). However, many years of biofeedback and psychophysiological research have demonstrated that a person can indeed control this nervous system when provided accurate feedback of its functioning. This is the basis of biofeedback.

What is Neurofeedback?
Neurofeedback (also known as “EEG-biofeedback”) is another form of biofeedback. Neurofeedback teaches psychophysiological self-regulation of the brain and in this regard is very different than peripheral biofeedback. To learn more about neurofeedback, please visit this page.

Top-Down / Bottom Up Treatments
Therapies that target the brain, such as talk therapy or neurofeedback, can be thought of as “top-down” treatments whereas peripheral biofeedback treatments can be thought of as “bottom-up.” In short, treatments that induce changes in the brain then affect the body (top-down), and treatments that elicit changes in the body then affect the brain (bottom). Dr. Fisher prefers to use both top-down and bottom-up approaches in treatment. This is why many of his patients who enter talk therapy will also learn HRV-biofeedback.

What Is the Most Common of Peripheral Biofeedback?
Peripheral biofeedback is most often used to teach relaxations skills. A brief description of each modality is provided below.

Heart-Rate Variability Biofeedback
HRV-biofeedback teaches diaphragmatic breathing for relaxation (and other uses). This is form a breathing the intentionally evokes use of the diaphragm. The diaphragm is the muscle that natured intended humans to breathe with. When anxious, individuals breathe in short, rapid, and shallow breaths – almost as if they are panting. And the lungs (as opposed to the diaphragm) are often used to breathe in these anxious states. Anxious individuals seem to naturally gravitate toward rapid breathing which can induce anxiety even if no true danger is present. They can literally live in a state of “fight or flight” simply because of their disordered breathing pattern. For example, a relaxed individual who is engaged in diaphragmatic breathing will breathe at a rate of around 6 breaths per minute (BPM), while an anxious person will breathe at a rate of 18 to 20 BPM or higher. The body’s impact on the brain is so profound that emotional anxiety can be induced simply by breathing more rapidly and, if done long enough, can even induce a panic attack – all simply by breathing differently. HRV-biofeedback provides the individual with: (1) a short term coping skill to quickly reduce anxious states – diaphragmatic breathing is incompatible with anxiety (i.e., it is hard to breathe diaphragmatically and be anxious at the same time) and (2) teaches long term breathing retraining so that the individual will automatically breathe more slowly with their diaphragm (i.e., even when they are not thinking about it).

Temperature-biofeedback trains an individual to raise or lower their body temperature on their hands or feet. The most frequent use is to raise body temperature. This is because when under stress, the body extremities become cold due to constricted blood vessels and blood being pulled toward the vital organs near the center of the body. Thus, when an individual raises their hand temperature, for example, they cause vasodilatation and increased blood flow to this region. Vasodilation is a sign of relaxation and the brain will detect this and become calmer with reduced anxiety.

Electrodermal Response (EDR) – Biofeedback
EDR-biofeedback trains an individual to decrease sweating. The most common site of training is the hands. When an individual is anxious, they naturally release sweat onto their skin. The sensors used in EDR-biofeedback are very sensitive and can detect even subtle changes in sweat. By decreasing sweat activity, relaxation is induced. An interesting phenomenon is that sweat gland activity is a highly accurate and sensitive marker of emotional changes. This occurs in near real time with the emotional state – even a change in thoughts will often elicit a detectable change in sweat gland activity.

Electromyography (EMG) – Biofeedback
EMG-biofeedback provides training of muscle electrical activity. Like the brain, the muscles produce measurable electrical activity that can be trained. The other modalities discussed above, EMG-biofeedback is also used to each relaxation skills; however, EMG-biofeedback is also utilized in muscle rehabilitation, incontinence, and other medically-based disorders that involve retraining of the muscles. A common treatment for anxiety, for example, is EMG-biofeedback for the frontalis muscle (forehead). When stressed, many individuals tense their facial muscles. In fact, you can experience emotional anxiety by simply tensing your face muscles long enough (make an angry face) – test it out! By relaxing the frontalis muscles, the individual will start to relax – they will also become aware of when they tense these muscles so that they can intervene before significant anxiety is produced.

What Other Disorders Are Amenable To Biofeedback?
Here are some disorders that peripheral biofeedback is commonly used to treat (this list is not exhaustive but only an example):

General Anxiety
Test Anxiety
Social Anxiety
Migraine Headaches
Tension-Type Headaches
Chronic Pain
Temporomandibular Joint Disorder (known as TMJD, TMD, and TMJ)

Here is a brief overview of Dr. Fisher’s biofeedback training. Dr. Fisher completed coursework at the PhD level in biofeedback at University of North Texas (UNT) and University of North Texas Health Science Center (UNT’s medical school). He received 5 years of supervised training in biofeedback. Dr. Fisher has worked in in-patient and out-patient biofeedback settings since 2005. Moreover, he has taught a graduate level biofeedback course at UNT. He was also a workshop trainer for professional-level neurofeedback/biofeedback workshops for many years. Please see the About section for Dr. Fisher’s complete background.

Dr. Fisher has written a number of review articles on peripheral biofeedback. Below are links to these reviews or editorials:

Biofeedback Applications for Tension-Type Headache: Results of a Meta-Analysis (research review)

Biofeedback May Be An Effective Treatment For Migraine Headache (research review)

American Academy Of Pediatrics Lists Biofeedback As A Level 2 Psychosocial Intervention For ADHD Symptoms (review)

Heart Rate Variability (HRV) Biofeedback Used In Virtual Reality High Performance Training (editorial of a press release)

Muscle (SEMG) Biofeedback Assessment Reduces Injury And Improves Worker Productivity (editorial of a press release)

Behavioral Treatments For Migraine Headache, Such As Biofeedback And Hypnosis, Are Cost-Effective Alternatives To Medications (editorial of a press release)

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