The American Psychological Association (APA) now recognizes biofeedback and applied physiology as a proficiency that helps consumers know that there are certain standards to indicate competence in this specialty within the practice of professional psychology. First, biofeedback providers must have a professional license under which they provide treatment. Second, it is recommended that these licensed providers also become board certified (BCB) by the Biofeedback Certification International Alliance (BCIA), the non-profit organization that has been certifying biofeedback practitioners since 1981. Dr. Del Pozo is a licensed clinical psychologist and also board certified in biofeedback.
What is biofeedback?
Biofeedback is a treatment used for a variety of mental and physical health conditions and consists of sensors placed on the patient’s body while physiological data is viewed on a computer screen or other monitor in real-time. It is considered a self-regulatory therapy because it is a tool for increasing awareness of and changing individual physiological responses to reduce symptoms or improve performance. The Association for Applied Psychophysiology and Biofeedback (AAPB), the Biofeedback Certification International Alliance (BCIA), and International Society for Neurofeedback and Research (ISNR) provide this standard definition:
Biofeedback is a process that enables an individual to learn how to change physiological activity for the purposes of improving health and performance. Precise instruments measure physiological activity such as brainwaves, heart function, breathing, muscle activity, and skin temperature. These instruments rapidly and accurately "feed back" information to the user. The presentation of this information -- often in conjunction with changes in thinking, emotions, and behavior -- supports desired physiological changes. Over time, these changes can endure without continued use of an instrument.
Biofeedback treatment may include use of one or more of the following modalities:
Galvanic skin response meter measuring eccrine sweat gland activity (skin conductance).
Thermistor measuring peripheral skin temperature.
Electrocardiogram or photoplethysmograph measuring peripheral blood flow, heart rate, and heart rate variability (HRV).
Electromyogram (SEMG) measuring surface neuromuscular responses.
Respiratory gauge and capnometry measuring breathing patterns, rate, and expired carbon dioxide.
Electroencephalography (EEG) measuring electrical activity of the cortex.
Although biomedical engineering and medical instruments have been used for over 150 years, most instruments are used for diagnostic information or passive treatment (i.e. scan or surgical device). Biofeedback devices are used to train people to increase control of their physiological responses through awareness, practice, and learning over time. It is valuable on a face value level, or “seeing is believing,” but the various biofeedback modalities also represent more complex activities of the central nervous system. A treatment goal is often to reduce sympathetic activation (stress response) and increase parasympathetic activation (relaxation response) of the nervous system, with more conscious control over each response.
What conditions are treated with biofeedback?
In 2002, a task force formed to rank how effective biofeedback is for different disorders. Biofeedback has evidence-based support for
chronic pain conditions including migraines, tension headaches, temporomandibular joint pain, and is also used for non-cardiac chest pain, arthritic conditions, irritable bowel syndrome, Raynaud’s disease, and other chronic pain conditions. There is evidence biofeedback may help related problems such as insomnia and anxiety, but often demonstrates comparable gains to cognitive behavioral therapy for these conditions. Thus, biofeedback is often used in conjunction with other therapies such as physical therapy or cognitive behavioral therapy, mindfulness and meditation.
What should I know as a patient?
Biofeedback is a multidisciplinary practice and may be used by psychologists, physical therapists, occupational therapists, nurses, physicians or other licensed healthcare professionals.
Biofeedback does not do anything directly to a person, but rather gathers information from a person. Similar to other learning therapies, the relationship between patient and therapist is important to generate positive outcomes.
Resources & Links
Del Pozo, J., Gevirtz, R., Scher, B., & Guarneri, M. (2004). Biofeedback increases heart rate variability in patients with known coronary artery disease. Am Heart Journal: 147(3) E:11.