March/April 2006

Journeys in mind

It's rare that a one-size-fits-all garment really fits anyone well. It's even rarer that a one-size-fits-all medical treatment provides relief. But biofeedback may be the exception to this rule.

Biofeedback, a method of learning to control some of your body's otherwise involuntary functions by aid of a visual or auditory display of body temperature, muscle tension, or several other measures, works primarily on stress-related conditions. Since stress is implicated in probably three-quarters of medical problems, that means biofeedback could be a mighty useful tool.

In addition, recently people recovering from strokes have used “biofeedback”—visual cues about muscle tension—to regain movement. Those with urinary or fecal incontinence also can learn to access the right muscles, regain control over them, and thus regain control over their lives to boot. Biofeedback began in the 1960s; those of us of a certain age may remember it from then—it was exciting to realize that we could choose to warm up our fingers by simply concentrating on a read-out. Back then, computers in everyday use were new, and any gadget that had a display panel was simply assumed to be a key to health, wealth or happiness. Biofeedback was cutting edge therapy, although it was always part of the standard scientific model.

Since then, two seemingly contradictory trends have changed the biofeedback world. One is that expectations have been lessened. Biofeedback can't fix absolutely everything (though it does a good job as either the primary treatment or an auxiliary treatment for a surprising array of physical complaints). There had been the hope that we could “will” ourselves to be more creative, or do away with drug treatments, or otherwise gain vastly greater control over our lives. It's clear now that biofeedback is no magic bullet.

The second is that as technology has progressed, so has biofeedback. Now, instead of measuring one thing—temperature of the fingertips—a good biofeedback setup provides clues to at least four biological functions (temperature, conductivity which indirectly represents endocrine function, muscle tension and blood pressure). With more data, we've got a greater chance of making healthy adjustments.

How does it work? It is based on reducing stress, which presents itself in many ways: increased heart beat, clammy, cold hands, shallow breathing, an increase in certain biochemicals, and tensed muscles. These are the ways the body leaps into action when, for instance, a bus is barreling down on us. It's good that our bodies are equipped to produce instant stress; we jump out of the way of the bus, take some deep breaths and return to our normal balance.

It's bad, however, when stress becomes chronic. It creates poor mental and physical health with a list of conditions longer than your arm. In a word, to stay healthy we've got to have ways to shut stress off, and biofeedback is a quick and direct approach to access the body's natural shut-off valves. (For more on this subject, see the interview with Stephen Porges in this issue of Nexus, page 30.) It sounded good, so I looked for anecdotal evidence to support it. The first user I talked with got no relief whatsoever for her migraines, never learned to warm her hands consciously and couldn't lower her blood pressure even after doing as instructed. But this patient admitted that she didn't like the time commitment that biofeedback required. And that's no small quibble. In the early years, learning biofeedback was a lot like learning transcendental meditation—you had to practice on a regular basis, perhaps a half hour per day. That kind of time is a precious commodity.

The techniques taught via biofeedback are simple; the willingness to take the time to do them may be difficult to sustain. Just as a condom won't protect you if its left in a drawer, biofeedback techniques won't work if they aren't used. These days, at least some certified biofeedback practitioners understand that time is in short supply. So, during office visits, the practitioner teaches relaxation to the client and probably offers other forms of help as well—physical therapy, ergonomic advice, or general health consultations. Clients see on the machine what their bodies are doing, they adjust, the machine immediately registers the change, and the presenting symptoms lessen. Repeat. The practitioner is a coach, not a fix-it man (or woman).

After a set of office visits, the client should be equipped with tools for all kinds of daily situations to promote relaxation. How about a few deep breaths? Even if you're in traffic, you'll have time for that. How about receiving relaxation reminders a couple of times per day via e-mail with mini visualization suggestions? How about having a set of exercises that take from one to 15 minutes, with no machinery required, and you choose which to do when? The challenge for biofeedback now is to make it user-friendly.

For those for whom biofeedback has been successful, finally having control over their headaches, digestive distress, chronic pain, or other condition is a godsend. The stories can be inspiring: One woman with an autoimmune disorder that repeatedly landed her in the hospital was told by doctors at the Mayo Clinic that she had to “learn to relax.” Doctor's orders, basically. She now incorporates massage, meditation and biofeedback into her routine life, and has a set of simple exercises she can do throughout the day to help her maintain her equilibrium. Not only is the autoimmune disorder under better control, her headaches have lessened as well. Another woman has learned to control high blood pressure without medication. She had tried biofeedback previously without success; this time, she says, it's the combination of the technology and the overall wellness attitude her practitioner brings to their work together that have made it successful. As part of her at-home assignments, she imagines her arteries opening up; by doing so, she not only brings her blood pressure down, which she measures herself at home, but also as a side benefit warms her perennially cold hands.

A 12-year-old boy has learned to “bring energy” to his hands by imagining a warm place, such as a desert. This, plus learning to breathing deeply, has helped him reduce the frequency of migraine headaches from almost every day to once every couple of weeks. The breathing may literally bring more oxygen to where it is needed but it also initiates a relaxation response. His life is in control now, not at the mercy of painful headaches.

Another client tried biofeedback because of a specific pain in her back. She'd been taught all her life to sit up straight, shoulders back, head up. The result was muscle tension, which developed into chronic pain. The more she tried to do what she thought was right, the tighter she became. The machine gave her immediate feedback that helped her find a more relaxed position. And it only took four sessions.

Several of these people commented that finding the right biofeedback practitioner was half the battle; if there isn't a good connection between practitioner and patient, it's not as likely to be helpful, regardless of the wonders of the computer program that puts those wavy lines on the display screen. Look for someone with a medical background and certification in biofeedback; ask for referrals; speak to your own health care provider; and then meet face to face for a trial session.

“Biofeedback” isn't a patented word, so it is sometimes used to describe processes beyond those I've written about. For instance, practitioners are using machines that measure bio-energetic information from 130 channels in the body and calling it biofeedback. These seemingly all-knowing biofeedback programs provide myriad data which the practitioner can use to figure out what supplements and therapies may be useful to a client. While this complex system is like traditional biofeedback in that it works with a conductive hookup between a patient and a machine, it is unlike it in that the patient is not asked to “learn” to control bodily functions by responding to the machine's outputs.

Just because biofeedback has been proven to be helpful for many kinds of conditions, doesn't mean that insurance is likely to pay for it. With a referral from a M.D. or other health care professional, you may be one of the lucky ones for whom insurance pays, but don't bet on it. More frequently people pay out of pocket for a set of four to eight sessions, and then come back once in a while for a “tune up.” This service may be as low as $75 per hour, but is more likely to be $120 or even $150. That might be the price of a good massage. You know the comparison between giving a hungry person a fish versus teaching them to fish? Maybe that's apt here: a massage promotes relaxation, but biofeedback teaches it.

Biofeedback Resources

• Boulder Biofeedback Center, Kate Harding; 303-247-9197; www.relaxandbreathe.com
• A Symphony in the Brain: The Evolution of the New Brain Wave Biofeedback, by Jim Robbins (Grove Press, 2001)
• Biofeedback and Somatics: Toward Personal Evolution, by Eleanor Criswell (Freeperson Press, 1995)
• Biofeedback, Third Edition: A Practitioner's Guide, by Mark S. Schwartz and Frank Andrasik (The Guilford Press, 2005)
• Biofeedback Without Machines: A Strategy for Living, by George E. Soroka (Ariel Starr Productions, 1996)
• www.biofeedback.net: The Biofeedback Network
• www.aapb.org: Applied Psychophysiology and Biofeedback
• www.bcia.org: Biofeedback Certification Institute of America (BCIA)
• www.bfe.org: Biofeedback Foundation of Europe