Biofeedback is a behavioral modality that teaches
you, the client, to self-regulate.
Biofeedback Is . . .
The body is made up of two different nervous systems: the central and the peripheral. The central nervous system consists of the brain and the spinal cord. The peripheral nervous system is basically every thing else. This system responds to external and internal stimuli. External stimuli are temperature, light, sound and other outside effects. Internal stimuli are anything related to your emotions, hormonal status and immune system. Traditional biofeedback is the measurement of your peripheral nervous system.
The peripheral nervous system reacts in many ways depending on the stimuli. Each reaction can be recorded on the biofeedback computer. The computer measures skin temperature, electrodermal activity, heart rate, muscle activity, respiration (capnometry) and brain waves. Each time you come to a session, your trainer will hook you up to the computer using the appropriate sensors. Each of these sensors are connected to an amplifier which translates the data into information the computer and you will understand.
The information travels from the amplifier to the computer, assessing the information and turning it into understandable images that advise the biofeedback experience.
Before explaining the different modalities, their hookup procedure and their optimal goals, it is important to understand the flight / fight stress response. This response occurs when we are approached by a stressor. A stressor is anything that effects our homeostatic state, whether internal (illness) or external (relational, societal, experiential issues).
Historically, external stressors were such things as lions chasing us or sudden natural disasters. Today, these stressors include work, traffic, health issues and relationship dynamics among many other things. Modern day stress can be chronic and our bodies were designed to handle the acute stress when once we overcame the stress, our bodies returned to homeostasis. Because today's stress is chronic, our bodies don't have an opportunity to return to homeostasis and we may remain in the flight/fight state. It is subtle, yet it exhausts to our system. Often it causes tension and migraine headaches, posture discomfort, muscle tension, elevated heart rate, depression, anxiety and brain wave irregularities.
Biofeedback can help you to become more aware of your physiological response to stress, teach you how to reduce the effort your body puts forth in maintaining a chronic stress state and finally regain a level of relaxation that would be favorable for dealing with new stressors.
Descriptions of The Modalities
A skin temperature thermistor is placed on one finger of one or both of your hands with medical tape (a stretchy medical tape that is breathable and adhesive to itself). The thermistor measures the temperature on the outermost or distal part of your body. (Actually your toes would be the most outer part, but this isn't as convenient as your fingers).
Why measure distal body temperature?
In the flight / fight stress response your peripheral nervous system shunts the blood away from your extremities and into your brain, heart and lungs, to aid in optimal performance in order to manage the acute stress. Warm peripheral skin temperature most often means homeostasis. It is common to work with skin temperature for migraine headaches, stress reduction, hypertension, Carpal Tunnel Syndrome and other repetitive motion injuries as well as Raynaud's Disease.
What is the goal?
The goal is to elevate your skin temperature into the low to mid 90*'s. When your extremities are warm, then the blood flow is balanced throughout your system. This is an indication that youвЂ™re not in a flight / fight arousal state. This is excellent training for aborting migraine headaches.
Electrodermal Activity (EDA)
The sensor for the Galvanic skin response or electrodermal activity is an amplifier connected to two Velcro-banded resistors. These are placed around the tips of two fingers or the palmar regions of one hand. They measure the conductance of moisture (sweat) on your hand's skin surface by sending a very small electrical current and recoding the speed at which it flows. This modality is a common part of the "lie detector" test.
Why measure EDA?
EDA is a measurement of eccrine sweat gland activity. When you become anxious, your eccrine gland system becomes aroused causing the glands to sweat. These glands are right under the skin of the palmar surface of your hands and feet and when active, indicate anxiety. We also train EDA for depression, sleep disorders, anger control, stress reduction and mind-body awareness
What is the goal?
For EDA when you are in a calm non-anxious state, your eccrine gland system is not activated, therefore your hands are dry. Conversely, if you are anxious, you will have clammy hands and your EDA measure reflects the difference. A goal zone for the EDA measure is relative to the state of the person. However, there are many variables that will cause one's EDA baseline readings to be extremely high or low.
Heart Rate Variability (HRV)
The heart rate monitor is a device called a photoplethmograph that is attached to a finger. Through light detection the PPM will determine when blood flow is pumped into or out of your finger tip. The pumping results from the beating of the heart and feeds back the heart rate and other measures of the heart.
Why measure heart rate?
The heart rate is useful when working on heart rate variability (HRV). HRV is the training method most useful in learning deep relaxation breathing. We look for coherence, or synchronization, of the breath and the heart. When one achieves the highest state of heart resonance, he/she can mediate many of life's stressors in a way that is fundamentally more healthful. Heart resonance work is also helpful in determining causes of anxiety, overarousal , hypervigilance and other nonfunctional body states. Heart resonance or heart rate variability is practiced for hypertension, mind-body awareness, stress reduction, depression, PTSD, sleep disorders and meditation enhancement.
What is the goal?
In HRV training you will learn to coordinate your respiration pattern with your heart rate. Your breath naturally becomes balanced with your heart rate results in optimal breathing for relaxation and in general life. There is no optimal heart rate level. However, most normal resting heart rates range between 45 and 80 BPM.
During biofeedback sessions, one can train with a simple breath analyzer, called a capnometer. The capnometer is a small canula (tube) that is attached under the nostril. It measures the end-tidal CO2 (ETCO2) or volume of CO2 that is exhaled.
One of the most important functions of breathing is to exchange fresh new oxygen (O2) with the carbon dioxide (CO2) that is the byproduct of metabolism. Venous blood, which is rich in CO2, returns from the body through the heart and is then pumped into the lungs, where it is exhaled. The oxygen that is inhaled replaces the CO2, which then travels through the heart and into the blood stream. This exchange creates an exhale that is rich in CO2. The measurement of CO2 released during exhale is called ETCO2 (end tidal CO2).
Why measure ETCO2?
When optimally breathing the inhale/exhale flow of breath keeps a balance of O2 and CO2. However, most of us are not breathing optimally, causing such syndromes as hyperventilation or hypocapnia. This creates a reduction of the concentration of CO2 in the blood, and can cause constriction of the blood vessels in the brain and heart, and constriction of the smooth muscles of the lungs and gut.
Hyperventilation and hypoventilation lead to dangerous shifts in blood chemistry. This causes more alkaline blood pH, which increases cellular excitability, higher O2 demands, higher anaerobic metabolism and antioxidant depletion. It can also cause a higher migration of calcium ions into the muscle tissue, which will increase the likelihood of heart arrhythmias, muscle spasms, fatigue and pain. As shown to the right, hypoventilation increases the blood flow, hyperventilation decreases it.
When we over- or under-breathe, we are effecting the amount of blood flow in the brain and changes in flow will alter it's functionality. Either may cause severe headaches or dizziness. Decreased blood flow may cause an inability to think clearly.
What is the goal?
This device, along with HRV, which includes a breathing gauge and heart rate monitor, brings awareness to the client of his or her breathing patterns. Analyzing these patterns, which can often include bracing, holding, breathing too deeply or shallowly, interrupting the breath flow with frequent yawning and/or breathing at an inappropriate rate for the current activity, will show the client what patterns should be changed.
The biofeedback sessions will then include a comprehensive training to help the client restructure his or her breathing mechanisms, an opportunity to practice them, and a careful look into understanding why these breathing patterns were adopted in the first place.
Muscle Activity | Neuromuscular Reeducation
The biofeedback computer is capable of measuring muscle activity through an electromyograph. The electromyograph (or EMG) is first hooked up to your trapezius muscles at the shoulder and at the sides of your forehead where your jaw muscle connects to your temporal muscle. These are two common sites for holding tension. We first prep the sites with alcohol. Then apply sticky sensors. There are many other sites where tension is held, posture can be corrected or muscles can be reeducated. After the initial stress profile and/or interview, we can determine the best placements for optimum benefit.
Why measure EMG?
When our muscles receive a message from a neuron to contract, either from our brain or as a direct reflex response from outside stimuli, the contraction lasts much less than a minute. It takes thousands and thousands of messages to fire neurons to maintain the contraction, which uses a lot of energy. That's OK if we're firing neurons in order to maintain posture or hold something voluntarily. However, often, when we remain in the flight/fight stress response, since we keep our muscles contracted for extended periods of time, the contraction becomes forgotten, hence involuntary. This is often referred as sensory motor amnesia, or SMA. It can create unbalanced postures or muscle tone that is exaggerated. SMA and flight/fight states will cause muscle electrical amplification to be high. EMG training is excellent for reducing the symptoms of tension headaches, TMD and bruxism, hypertension, stress reduction, chronic pain and repetitive strain injuries, Carpal Tunnel Syndrome and affords mind-body awareness.
What is the goal?
The goal in EMG training is to lower the electrical amplitude. Since neuronal firings are essentially electrical impulses, the computer can calculate the measurement in microvolts, or uV. The goal for EMG training is generally between 1 - 3 uV during relaxation. This measurement indicates that there is very little electricity emanating from the muscles under which the sensors are located and thus there are no unnecessary contractions.
The EMG, strain gauge and heart rate sensors are used in relaxation training. The strain gauge is a velcro strip attached to the midsection just below the waist. It measures the difference in expansion and constriction of the abdomen when inhaling and exhaling, which is an indication of the diaphragm's activity. It shows how deeply one is breathing. The heart rate and strain gauge together determine your optimal breathing pattern. The EMG sensors show where and when the painful muscle groups are relaxed or stressed.
Why train relaxation?
Often times, the feeling of relaxation is incongruent with what is actually occurring within the muscle group. This is because the stressful feeling becomes the norm. Through careful study and work, you will be able to notice and change when the muscles are tense and relax them. The lower-aroused state of the muscles become a new homeostasis.
What is the goal?
Biofeedback sessions are designed to teach you what you can do to alleviate pain symptoms and become more aware of what your body is doing at any time. It is important to practice the breath work and the relaxation exercises as often as possible between sessions. Before long, you should be able to enjoy doing the activities you love in a pain- and stress-free way. This work will build a foundation for more healthful habits and discourage the onset of chronic flight/fight existence.
Is biofeedback reimbursable by health insurance?
More and more insurance companies are recognizing biofeedback as a viable modality for many health related problems. Some companies require a prescription from your primary caregiver, some don't. We recommend you call your provider or third party payer and ask them what they need in order for you to be reimbursed. The CPT code for biofeedback (the intervention) is 90901.
How many sessions will it take?
This is a hard question to answer because people come in for many different health problems. Stress reduction techniques generally take about 4 to 8 1-hour sessions. Other more complicated cases can take up to 30 sessions.
What is the time required per week for biofeedback to work?
Biofeedback is a learning process, just like learning to play a musical instrument. The more you practice, the better you get at it. A one-hour session each week and about ten to fifteen minutes per day doing home practice is best for most cases. This practice can take place at work, at home, right before bed or in the morning.
How do I get started?
Call Marin Biofeedback and set up an interview (415) 485-1342. The interview takes about 1 to 1 1/2 hours. After assessing your needs, we'll perform a physiological stress profile. We will then confirm the correct treatment and schedule subsequent sessions.
What does it cost?
Biofeedback sessions range from $95.00 to $150.00 per session. Marin Biofeedback offers prepayment discounts.
Biofeedback and Somatics: Toward Personal Evolution | Eleanor Criswell, EdD | Freeperson Press ISBN 0-918236-06-1
Psychophysiology, The Mind Body Perspective | Kenneth Hugdahl | Harvard Univ. Press ISBN 0-674-72207-8
Psychophysiology, Human Behavior and Psychophysiological Response 3rd Edition | John L. Andreassi | Erlbaum Associates ISBN 0-8057-1104-4
Why Zebras Don't Get Ulcers 3rd Edition | Robert Sapolsky Holt Paperbacks | ISBN 10-0-8050-7369-8