The greatest revolution of our time is the knowledge that human beings, by changing the inner attitudes of their minds, can transform the outer aspects of their lives.
-William James Jonathon Sikorski, PhD LP Tria Conflict of Interest and Disclosure Objectives
common applications of biofeedback to treat psychological Review disorders
Identify misconceptions of biofeedback practices
Discuss ways biofeedback can help improve wellness
POLL What is Biofeedback?
Bio Feedback Body Information Biofeedback is information
You probably use biofeedback every day without recognizing it. You obtain heart rate biofeedback after a run using a watch and your index finger. Biofeedback is information Central Nervous System Perception - Narrowed Autonomic Nervous System Memory - Coarse, Imprecise Heart rate Learning - Blocked Blood pressure Conditioning - Defense Oxygen need Tendency - Regress or Perseverate Breathing rate Expectancies - Negative Palms, face sweat Tone - Flee or Destroy Blood sugar Adrenalin flows Digestive tract shunts blood to muscles Blood vessels constrict in hands Muscular System and face Tension Ready for Action Jaws Clench Body Braces for Action
Image from Sapolsky, 2005 Nothing new under the sun.
• Nebraska Psychiatric Institute used to use EEG biofeedback under the guidance of Dr. Stephen Paige and Dr. Ellingson • NPI used to conduct research on using biofeedback to help treat addiction and pain Things have changed
One device can effectively measure: • Heart rate variability (HRV) • Muscle Biofeedback (sEMG) • Neurofeedback (EEG) • Respiratory biofeedback (C02) • Sweat gland biofeedback (Skin conductance) • Temperature biofeedback (Finger) • 65 to 84 percent of all medical visits are lifestyle related (AMA, 2016) • Less stigma easier for patients to engage Why • Focus on mastery instead of self- biofeedback? efficacy • Empirically shown to be effective for many disorders • Less invasive than some medical treatments What biofeedback is not
A diagnostic tool
An intervention… more of training tool POLL Who makes a good biofeedback patient?
Individuals who want a more active role in their own health care
Ones looking for non-invasive treatment options
Those who WANT or NEED alternatives to meds
Cases involving past trauma
Patients who express hopelessness or helplessness
Multi-symptom, complex cases in which conventional interventions have minimal success
Pain patients with secondary anxiety, depression, insomnia, PTSD, etc.
NOTE: Skeptics are welcome! Major types of biofeedback Professionals use these tools to treat medical and psychological disorders, and to train athletes and musicians to achieve optimal performance. Heart rate variability (HRV) biofeedback uses sensors placed on a finger or earlobe, or on your chest and lower torso, or wrists to measure the time interval between each heartbeat.
Major types of biofeedback HRV biofeedback is used to treat anxiety, asthma, heart disease, depression, high blood pressure, irritable bowel disorder, Posttraumatic Stress Disorder (PTSD), and unexplained abdominal pain.
Major types of biofeedback Major types of biofeedback
Muscle (or EMG) biofeedback uses sensors placed over skeletal muscles to monitor the electrical activity that causes muscle contraction. Muscle biofeedback is used to treat disorders as diverse as anxiety, asthma, cerebral palsy, headache, high blood pressure, low back pain, spinal cord injury, and stroke.
Major types of biofeedback Neurofeedback (EEG biofeedback) uses scalp sensors to monitor the brain’s electrical activity. Respiratory biofeedback uses sensor placed around the abdomen and chest to monitor breathing patterns and respiration rate. Major types of biofeedback Major types of biofeedback
• Respiratory biofeedback is used to treat anxiety, asthma, chronic obstructive pulmonary disease (COPD), hyperventilation syndrome (HVS), and high blood pressure. Major types of biofeedback
Sweat gland biofeedback uses sensors placed on the fingers or palms to monitor changes in skin moisture produced by sweating. Sweat gland biofeedback is used to treat excessive sweating Major types of (called hyperhidrosis) biofeedback and high blood pressure, and to teach relaxation. Major types of biofeedback Finally, temperature biofeedback uses sensors placed on the hands or feet to measure blood flow to the skin. Major types of biofeedback
Temperature biofeedback is used to treat headache, high blood pressure, Raynaud’s disease, and swelling. In God we trust… Everyone else needs to bring data… Levels of evidence of efficacy (Khazan, 2016) 1. Level 1 – Not empirically supported 2. Level 2 – Possibly Efficacious 3. Level 3 – Probably Efficacious 4. Level 4 – Efficacious 5. Level 5 – Efficacious and specific Level 3
• Alcohol and substance abuse • Insomnia disorders (EEG) • Motion sickness • Arthritis • Performance enhancement • Autism (EEG) • PTSD • Chemobrain (EEG) • Traumatic brain injury • Diabetes • Tinnitus • Facial palsy • Urinary incontinence in men and • Fecal incontinence women • Fibromyalgia • Headaches, pediatric Level 4
• Anxiety • Hypertension • Depressive disorders • Irritable bowel symptoms • Epilepsy (EEG) • Migraine headaches • Constipation • Preeclampsia • Diabetes mellitus • Raynaud's disease • Erectile dysfunction • Repetitive strain injury • Fecal incontinence • Temporomandibular joint • Headaches (adults) disorder Level 5
• ADHD (EEG) POLL Substantiated Results in the Literature
• Reduces blood pressure in hypertension (McCraty, 2001) • Improves asthma (Lehrer, 2000) • Increases calmness and well-being (Friedman, 2000) • Increases emotional stability (McCraty, 2001) • Improves cognitive performance (McCraty, 2001) • Improves hormonal balance (McCraty, 1998)
34 Home Training
Institute of HeartMath’s emWave 2. $199 US. Thought Technology Ltd.’s eVu TPS. $395 US. Institute of HeartMath’s Inner Balance. $129 US. Home Training
emWave Pro without HRV Assessments. $299 US. emWave Pro Plus with HRV Assessments. $499 US. Home Training
Plain alcohol thermometers (100). $65 US.
Stress Thermometer SC 911. $20 US. Applications
Breathe Breathe2Relax Breathe Sync Breathing Zone Applications
MyBreath MyCalmBeat Applications
Institute of HeartMath Coherence Coach. $19.95 US. Applications
BFE EZ-Air Plus. $19.95. Applications
Wayne Martin’s free HRV biofeedback recordings. Freespiria for panic disorders (Tidal C02)
Case example: Cold hands, Warm Heart
Kathy “Ice Hands” McFee - 43 yo Caucasian woman - Developed bilateral CRPS after left hand carpel tunnel release and left trigger thumb surgery (outside Tria) in June 2017 - Seen at Tria pain clinic August 2019 - Referred to pain psychology Nov. 2019 Pain information
• Left hand 5 to 6 / 10 up to 10/10 • Right hand 4 to 5 / 10 up to 9/10 • “Gloves of Fire” • Stabbing needle sensations • PHQ-9 score 11 • GAD-7 score 13 • PCS – 15 • Pain impacts ability to maintain job, increased parenting stress and guilt due to inability to lift/play with young children during pain flares What does a session look like? Cleaned data – Chronic Pain Pt. Hand Temperature and GCS After Visit & Next Steps
• Two weeks following • Working on HRV appointment • ACT for defusing from thoughts • Left hand Pain 1 to 2 / 10 about pain • Right hand pain 3 to 5 /10 • RFA for right arm • Continues to meditate 10 minutes each morning within first hour of waking up • PHQ-9: 7 • GAD-7: 6 Any Questions?