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DEFINITION

Biofeedback is a behavioral therapy method that teaches a patient to gain greater awareness and control over physiologic functions, including some not normally under conscious control. This is achieved by using technology that presents to the patient in visual or auditory form the level of activity of a physiologic parameter, such as muscle tension, skin temperature, sweat gland activity, respiratory muscle activity, PCO2, heart rate variability, or brain wave pattern.

HISTORY

Biofeedback began in the 1950s with the work of the experimental psychologist Dr. Neil Miller. He demonstrated that rats could learn to regulate autonomic functions when motivated by painful or pleasurable stimuli. The idea that autonomic function could be volitionally controlled was contrary to the scientific dogma of the time. In the 1960s, other researchers began to examine the human ability to consciously alter physiologic function.

TRAINING & CERTIFICATION

Certification is obtained through the Biofeedback Certification International Alliance (BCIA) and is open to professionals from clinical health care areas including, but not limited to, psychology, nursing, and counseling. Requirements for certification are as follows: (1) 48 hours of didactic education; (2) 20 hours of contact spent with a BCIA-approved mentor, 50 patient/client sessions, and case conference presentations; and (3) successful completion of a written certification examination. There is also a continuing education requirement.

When treating a medical or psychological disorder, biofeedback practitioners are required to hold a current state license in a BCIA-approved health care field or, if without this license, work under the supervision of an appropriately credentialed health care professional. Separate, additional certificates are required for electroencephalographic (EEG) biofeedback (neurofeedback) and pelvic muscle dysfunction work.

CLINICAL PRACTICE

Since biofeedback is a taught, self-regulatory skill, patients should be motivated; prepared to take an active role in their treatment; respond well to visible, quantifiable information; or have aptitude or familiarity with technology. Typical biofeedback sessions last 50 minutes, with half or more of that time in active monitoring. To begin a biofeedback session, the therapist applies sensors to the patient that monitor the physiologic parameters of interest. For example, in a case of chronic tension headache, an electromyographic (EMG) sensor may be applied to the skin of the forehead. Information from the sensor feeds back to the patient as sound or as an image on a computer screen in real time, so he or she can begin to learn to reduce tension in the forehead muscle. Multiple sessions are usually required, and the patient is asked to practice the learned skills between sessions. The goal of biofeedback is to help the patient train himself or herself to produce the desired response at other times. Some biofeedback software programs and sensors are available for use on a home computer or with portable electronic devices.

ADVERSE EVENTS & CONTRAINDICATIONS

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