Biofeedback Research Paper

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Biofeedback is a methodology as well as a clinical tool that provides information about an individual’s physiological functioning in relation to her cognitive, emotional, and behavioral responses. This research paper will present a psychobiological approach in discussing the development of biofeedback, theoretical models, types of biofeedback, current research status, and applications of biofeedback.

Outline

I. Introduction to Biofeedback

A. Definition of Biofeedback

B. Historical Survey of Biofeedback Development

II. Theoretical Models of Biofeedback

A. Operant Conditioning Model

B. Information Processing Model

C. Theory of Voluntary Control

D. Psychobiological Model

III. The Biofeedback Laboratory

A. Components of the Biofeedback Laboratory

B. Establishing a Biofeedback Laboratory

C. Safety Considerations

IV. Types of Biofeedback

A. Electromyographic Biofeedback

B. Skin Temperature Biofeedback

C. Galvanic Skin Response Biofeedback

D. Electroencephalographic Biofeedback

E. Heart Rate, Blood Pressure, Pulse, and Volume Biofeedback

F. Sexual Response Biofeedback

G. Gastrointestinal Biofeedback

V. Current Research Findings in Biofeedback

A. Research on the Best Methods of Biofeedback

B. Research Investigations on How Biofeedback Works

C. Research on Differences between Children’s and Adults’ Responses to Biofeedback

VI. Clinical Use of Biofeedback

A. How and Why Biofeedback Is Used in Clinical Settings

B. Biofeedback, Relaxation Training, and Stress Management

C. Clinical Issues in Using Biofeedback

VII. Opportunities in and Future of Biofeedback

A. Professional and Research Opportunities

B. Future Directions in Research, Clinical Practice, and Biofeedback Technology

I. Introduction to Biofeedback

A. Definition of Biofeedback

Biofeedback is any process in which an external device generates information to an individual about his or her physiological responses and that allows the individual to then regulate these responses and receive feedback on changes in the physiological responses. The physiological responses may be any responses that can be measured by an external device. The most common responses measured are muscle tension, heart rate, skin-temperature, and galvanic skin response. The feedback may be in a variety of forms, the most common being visual and auditory. The feedback may be continuous, intermittent, or provided once a threshold is crossed.

Biofeedback can also be considered a methodology used in studying psychophysiological processes. The methodology includes a baseline measurement of the physiological response(s), then feedback is given to an individual with some sort of instruction to manipulate the physiological response(s). The physiological response is measured during feedback and compared to the baseline measurement. Inferences are then drawn as to the relationship between the physiological response and the individual’s response to the biofeedback.

B. Historical Survey of Biofeedback Development

Psychophysiology is the scientific study of the interrelationships between cognitive, emotional, behavioral, and physiological processes. Biofeedback techniques and applications grew out of the research in psychophysiology. Biofeedback research became widespread in the 1960s, when studies reported that a variety of presumable nonvoluntary responses could be brought under operant control. Many studies using electroencephalographic feedback were reported which indicated that alpha brain activity could be brought under voluntary control. As these studies gained the attention of clinicians, soon biofeedback was applied to treating various disorders such as migraine headache and hypertension. The growing body of research on stress also provided support for the use of biofeedback as a research tool as well as a treatment approach. Research on the effects of relaxation, meditation, and hypnosis in producing the relaxation response to counteract the effects of stress provided further support for the concept of self-regulation using biofeedback. Advancing technology provided more efficient, reliable, and sophisticated instrumentation that has allowed for greater in-depth study and validation of applied biofeedback. Researchers also became interested in evaluating the various theories being proposed regarding how and why biofeedback works.

Biofeedback experimentation and methodology represents a major advance in the scientific evaluation of the relationships between behavior, environment, and the regulation of physiological processes. Some historians suggest that it is the single most significant development to occur in the area of psychophysiology. Biofeedback methodology has widened the scope and increased the capability of behavioral models of experimentation and analyses in research on physiological functioning and self-regulation. It has stimulated interest in behavioral models of etiology and treatment of psychophysiological disorders. Biofeedback experimentation has provided evidence for new approaches to the alteration of emotional states and the study of consciousness.

II. Theoretical Models of Biofeedback

Over the years several models have been proposed that attempt to describe what processes and principles allow biofeedback to work. Four of the more popular models will be briefly described: these are the operant conditioning framework, the informational processing model, the skills learning model and the psychobiological model of self-regulation.

A. Operant Conditioning Model

The operant conditioning model is basically atheoretical. This approach emphasizes the use of reinforcement, positive, negative, and punishment, that are made contingent on selected ongoing physiological responses, and the learning that follows the application of reinforcement. Research in this area has focused on a variety of conditioning principles, physiological responses, and human and animal behavior. The emphasis has been on examining similarities and differences between conditioning of skeletal motor and visceral or neural processes within the individual. Systematic exploration of operant techniques has not occurred and there needs to be a more consistent examination on the effects of the environment on physiological regulation. Examples are evaluating the effects of combining different schedules and types of reinforcement with the feedback on a person’s ability to learn to change a physiological response.

B. Information Processing Model

In defining biofeedback training, the concept that the individual is ‘‘fed’’ ‘‘back’’ information about biological responses that he or she is not aware of is important. This information provides a sensory analog of the currently occurring physiological responses. Information is provided to the individual at the same instant that the physiological activity is occurring or after a very brief delay. Therefore, some part of the output of a process is now introduced into the input of a process so as to alter the information processing. According to the information processing model, biofeedback stimuli can be conceived of as a symbolic representation of the physiological event, and the individual engages in a response to either reduce or enhance the biofeedback stimuli, resulting in changes in the physiological responses themselves. Research in this area may evaluate different types of feedback stimuli to determine the best display of information. This may include examining the differences between auditory and visual feedback.

C. Theory of Voluntary Control

The theory of voluntary control proposed by Brener emphasizes discrimination and awareness of internal bodily responses and processes. Biofeedback is thought to aid the individual in the learning process and increase awareness of sensations related to physiological responses, or to sensitize the individual to other motor responses as a means of mediating voluntary control over the physiological changes. Thus, emphasis is given to learned physiological control as a form of complex human learning of motor skills.

D. Psychobiological Model

All three of the theories discussed thus far have been supported by some empirical data. There are a number of studies that attempt to isolate and differentiate the effects of the hypothesized variables. At this stage of knowledge, there is no strong empirical evidence to support one viewpoint over another. The psychobiological model integrates these concepts by emphasizing the interrelationships between psychological processes and biological processes. The psychobiological model supports the view that biofeedback helps the self-regulation of the individual’s total functioning. The concepts from the information modeling approach provide a way to explain how needed feedback is provided that will allow for better self-regulation. The concepts from the operant approach are used to emphasize the individual differences in effectiveness of various types of feedback and schedules of reinforcement, and the importance of considering environmental influences in self-regulation. Finally, the theory of voluntary control helps explain how individuals can adjust their current motor responses to impact on processes that they are not aware of.

III. The Biofeedback Laboratory

A. Components of the Biofeedback Laboratory

The biofeedback laboratory should be a quiet room free from visual distractions. A recliner chair allows the subject to rest comfortably. The laboratory equipment can vary depending on the goals of the clinician and purposes for which the biofeedback will be used. With the advances in technology, most biofeedback systems are quite compact and attractive. Some of these systems are integrated with a computer screen and will allow for printing of and/or computer display of the feedback. A computer system is advisable so that the results of the biofeedback session can be stored for future reference. Biofeedback instruments monitor physiological responses of interest and allow for measurement of these responses. The instrumentation then presents it in a way that the individual can use and manipulate the information.

Electrodes and transducers convert responses from the skin’s surface that are transformed to electrical impulses that go to a preamplifier and then to an amplifier. The amplified signal then drives an output device such as an audio signal or visual display. Electrodes are used to detect electrical currents from one electrode to the next. Transducers come in a variety of forms. A thermistor is one type of transducer used to detect heat. A photoplethysmograph is a transducer used to detect changes in density of the skin as a result of changes in blood volume. And a strain gauge is a transducer that measures mechanical changes, such as the movement of some part of the body.

B. Establishing a Biofeedback Laboratory

A minimum requirement would be to establish a large enough area that could hold a recliner, a chair for the individual conducting the biofeedback session, the biofeedback equipment, a personal computer, and lighting that can be dimmed. After space is established for the laboratory then the practitioner would begin searching for the type of equipment that would serve the goals of the practitioner. There are several nationwide companies that can be contacted to provide bids on biofeedback equipment. Some individuals prefer to buy individual biofeedback components for each response, often called ‘‘stand alone’’ modules. Another approach would be to purchase the preamplifier/amplifier components that various transducers and electrodes could be plugged into. In order to connect the biofeedback equipment to a computer a component called an analog-to-digital converter needs to be purchased.

C. Safety Considerations

There is a small chance of electrical safety problems when using biomedical instrumentation. In order to minimize risks Schwartz and associates in 1987 suggested that each power line piece of auxiliary equipment be evaluated periodically for electrical safety; all individuals should be kept out of arm’s reach of all metal parts; and equipment should be properly grounded.

IV. Types of Biofeedback

A. Electromyographic Biofeedback

Electromyographic (EMG) biofeedback is the most widely used biofeedback technique with both children and adults. EMG biofeedback provides information about the individual’s striate muscle tension in the area where the electrodes are attached. As the muscle constricts it generates an electrical current between one motor neuron and the next. The EMG sensors pick up the intensity of that electrical current. Typically, there is one reference electrode that is used and two active electrodes. It is important to place the electrodes lengthwise over the muscle of interest so that the electrodes are picking up the electrical current as it moves from one motor neuron to the next within the same muscle. If the electrodes are placed on two different muscles, then the information obtained reflects the electrical difference between two different muscles. The muscles most commonly monitored are the frontalis, masseter and trapezius muscles. The frontalis is the forehead muscle that tenses when an individual is worried or under pressure. Some clinicians believe the tension in the frontalis area is one of the best indicators of overall body tension. The masseter muscle is connected to the jaw bone and contracts when an individual is tense or angry. The trapezius muscle contracts the shoulders when an individual is alarmed or chronically anxious. These muscles are often the focus in biofeedback training because they typically respond to stress and can be measured without much interference from other muscles. They can be a good starting point from which muscle relaxation training can be generalized.

B. Skin Temperature Biofeedback

Skin temperature feedback monitors fluctuations in surface body temperature. These are most often measured by monitoring finger, hand, or foot temperatures. A sensor is usually attached to the index finger of the hand. The sensor, a thermistor, is a heat-sensitive semiconductor in an epoxy bead.

Skin temperature monitoring is useful because skin temperature tends to become cooler as one experiences greater sympathetic nervous system (SNS) arousal and stress. Peripheral vasoconstriction and reduced blood flow to the tiny capillaries in the skin are what causes the skin temperature to decrease. During SNS arousal, changes in blood flow takes blood from the skin and sends it to the skeletal muscles, allowing large muscles to respond to the flight or fight challenge. This response in turn protects the peripheral parts of the body, by reducing blood flow to the hands or feet in order to reduce bleeding if these body parts were injured. Thus, it is suspected that when the person experiences greater parasympathetic nervous system arousal, changes in blood flow return the blood to the skin and smooth muscles. Increased blood flow to the skin causes increases in skin temperature, and this may reflect relaxation.

C. Galvanic Skin Response Biofeedback

A feedback dermograph measures the electrical conductance or electrical potential in the individual’s skin. The galvanic skin response (GSR) biofeedback machine can monitor minute changes in the concentration of salt and water in sweat gland ducts. The natural metabolism of cells produces a slight voltage that varies as sweat gland activity changes. The lower the measurable voltage, in millivolts, the less there is of sweat gland activity. With skin conductance techniques an imperceptible electric current is passed through the skin. As the sweat glands become more active, the monitor registers the skin’s increased ability to conduct electricity. The reverse of this procedure is called skin resistance.

The GSR has been used in lie detectors as a measure of emotional arousal. The sympathetic branch of the autonomic nervous system controls sweating. GSR biofeedback helps the individual gain control of the arousal produced by the autonomic nervous system. Two sensors or electrodes are usually placed on the ends of two fingers. Many clinicians prefer not to use GSR responses because they change rapidly and often respond to irrelevant stimuli.

D. Electroencephalographic Biofeedback

Electroencephalographic (EEG) biofeedback is another frequently used biofeedback training method with children and adults. EEG biofeedback gives information about the brain’s electrical activity. Brain waves have been classified into four states: beta, which occurs when the individual is wide awake and thinking; alpha, which is associated with a state of calm relaxation; theta, which reflects a deep reverie or light sleep; and delta, which is associated with deep sleep.

In the typical procedure the subject is provided with feedback about the presence or absence of some specified amplitude and/or frequency of brain electrical activity. Often the goal of EEG biofeedback is to produce alpha waves because they are associated with relaxation.

E. Heart Rate, Blood Pressure, Pulse, and Volume Biofeedback

The heart rate monitor uses electrodes to measure the action of the heart muscle. Heart rate biofeedback usually involves measuring heart beats per minute. In general, greater SNS arousal is associated with a faster heart rate, and a relaxed state is associated with decreased heart rate. Blood pressure biofeedback monitors the diastolic and the systolic pressure of the cardiovascular system. Increases in blood pressure reflect greater SNS arousal; thus, in most cases the goal of blood pressure biofeedback is to reduce the pressure. Blood pressure is difficult to monitor as one has to use a blood pressure cuff that must be inflated and deflated to measure the changes in pressure. It is has been shown that the inflating and deflating of the cuff actually alters the blood pressure response. Newer technologies have been developed to overcome this problem; however, they are more expensive.

Blood pulse and volume are measured using a photoplethysmograph. A photoplethysmograph generates a small amount of infrared light that is monitored with a light sensor. As blood volume increases the density of the skin increases and less light passes through the skin and is reflected back and is registered by the light sensor. Blood volume feedback helps the individual constrict or dilate the blood vessels or artery being monitored. Blood pulse is also measured with a photoplethysmograph and is often used as an indirect measure of heart rate.

F. Sexual Response Biofeedback

Sexual arousal in males is usually measured by penile tumescence. A strain gauge is used and it measures the physical changes of the penis as arousal increases and decreases. Female sexual arousal is measured with a thermistor or photoplethysmograph that is placed near the clitoris. Sexual response biofeedback may be used in the treatment of sexual deviations as well as sexual dysfunctions.

G. Gastrointestinal Biofeedback

Measuring the activity of the gastrointestinal system can be accomplished by measuring the electrical activity on the surface of the skin where the stomach is. Muscular activity is screened out. Greater electrical activity is related to greater stomach motility. This type of biofeedback may be useful in treating stomach disorders that are affected by stress and anxiety.

V. Current Research Findings in Biofeedback

A. Research on the Best Methods of Biofeedback

Studies indicate that initially feedback should be salient to the individual, continuous and given when small changes are made. As the individual begins learning to manipulate the response, then feedback can be contingent on greater change and may be given intermittently. The clinician can experiment with a variety of forms of feedback, many people prefer audio feedback as they can close their eyes while trying to relax.

It is important to include segments of ‘‘self-control’’ training in which the feedback is turned off and the individual is instructed to continue to manipulate the response without feedback. Research also indicates that home practice is necessary for lasting changes to occur. Practicing self-control of the physiological response for 10 to 20 minutes several times a week is recommended. It appears that it is best to have the patient plan out the practice schedule ahead of time and to practice earlier in the day. If the patient waits until right before they go to sleep they may fall asleep during the practice. As the patient gets better at controlling the response, he or she should be encouraged to do this while continuing normal activities.

Studies indicate that changes in symptoms come slowly with most changes occurring four to six weeks after biofeedback therapy has begun. It is important to explain to the patient that biofeedback does not work like most medication and that changes occur slowly and often accompany a real change in the person’s behavior and attitude about the problem and how to cope with it. Also, biofeedback may not eliminate the symptoms but it may reduce the intensity, frequency, and/or medication usage.

B. Research Investigations on How Biofeedback Works

In the late 1970s and early 1980s research in biofeedback was focused on evaluating the different models of biofeedback discussed above. Many interesting findings were reported, but more questions were raised than were answered as to how biofeedback works. Much of the recent research on biofeedback has focused on evaluating the clinical efficacy of biofeedback, and little systematic work is now being done on discovering how it works. In order to address the question of how it works some researchers have attempted to design false feedback studies. Results of these studies have been mixed, with some studies reporting that even when false feedback is given subjects alter their response as instructed. Some researchers have compared biofeedback training with relaxation only and found that in both conditions, decreases in ANS arousal can be achieved. Other researchers are now examining the role of cognitions in the biofeedback process. The bottom line is that we are not sure how it works but studying this question allows for a fascinating journey into the mind-body research arena.

C. Research on Differences between Children’s and Adults’ Responses to Biofeedback

In general children are more open and responsive to biofeedback than adults. Children are usually fascinated with the equipment, and motivation and curiosity are high. Research on nonclinical populations response to biofeedback indicate that children between the ages of 8 and 12 are able to achieve greater changes in physiological responses using biofeedback than any other age group. For clinical groups biofeedback may be a good alternative to medication if the medical treatment has potentially negative short- and long-term consequences for the developing child. Research evaluating the effectiveness of biofeedback with children who have headaches indicates that more children improve and to a greater degree than do adults.

Besides play therapy, behavior modification, and some of the newly developed cognitive strategies, there are only a few individual therapy techniques to be used directly with children. Most interventions involve changing or teaching parenting skills, or manipulating the child’s environment. Biofeedback offers the therapist a mode to teach the child concepts of self-control, stress management, and an opportunity to begin talking about feelings and stressors and how these may affect physical health. Most children have an external health locus of control in which powerful others have responsibility for their health. Biofeedback may help the child gain an internalized view that acknowledges one’s own role in maintaining good health.
Although children may be more responsive in the therapy setting, they may have greater difficulty than adults in remembering to practice outside of the therapeutic settings and to record changes in their symptoms. Often a parent is recruited to gently remind the child to practice and record symptoms.

VI. Clinical Use of Biofeedback

A. How and Why Biofeedback Is Used in Clinical Settings

A major use of biofeedback is to teach relaxation skills. A second use of biofeedback is to alter pathophysiological processes such as blood flow or SNS arousal for migraine headache patients, to decrease the flow of gastric juices for ulcer patients, to decrease muscle tension and increase proper posture for the chronic back-pain patient. Biofeedback should be considered as a therapeutic tool that can help introduce the client to therapy in a concrete and nonthreatening manner. It can be especially useful for the patient who focuses on physical problems or insists his problems are not physiological. Biofeedback can also be used to increase feelings of self-efficacy and self-control. The client learns quickly the connection between emotions, thoughts, and physiological responses.

Biofeedback may be used when there are no viable medical alternatives, or when the physician determines that medication should not be used. Sometimes patients do not want to take medication and biofeedback may be a treatment alternative. For example, a chronic back-pain patient may have to use pain medication to control the pain for the rest of her life because there are no other medical treatments to reduce the pain. The patient may choose to try biofeedback to help cope and reduce the pain instead of taking pain medication, which is addictive and may have undesirable side effects.

Biofeedback has also been used in modifying behavioral problems. Two examples are hyperactivity that is associated with attention deficit disorder and maladaptive behaviors that are associated with mental retardation. Motor responses may be monitored using biofeedback; the child is rewarded as the problem behavior decreases.

Biofeedback should be used clinically only after a competent medical diagnosis has been made and the examining physician has decided that biofeedback may be valuable. Patients coming directly to psychologists for biofeedback or other behavioral treatments of physical disorders should be referred first to a medical specialist for a thorough medical examination. The need for medical consultation in any biofeedback case is both an ethical and legal responsibility of the psychological practitioner.

B. Biofeedback, Relaxation Training, and Stress Management

The question has been raised as to the difference in effectiveness of outcome between biofeedback and relaxation training in reducing stress. This has been a controversial question as many clinicians and researchers argue that you can get the same benefits from relaxation strategies as from biofeedback for most problems. Furthermore, they point out that the relaxation strategies are not as costly nor do they require knowledge of complicated equipment. Only a few large-scale controlled outcome studies on the efficacy of biofeedback as compared to other behavioral techniques in the management of physiological disorders have been reported. Most of these do not find that biofeedback provides a distinct advantage over other behavioral procedures. The selectivity of physiological control often achieved by biofeedback methods would suggest that the methods would have a unique advantage in disorders in which the symptom is quite specific, for example, cardiac arrhythmias, seizure disorders, and various neuromuscular disorders. However, at the present time there is not enough research evidence to discount the idea that biofeedback may be better for some disorders, and that some people may respond better to biofeedback than relaxation therapy. As technology advances equipment is becoming less expensive and more user ‘‘friendly.’’ Biofeedback may be particularly useful for children as cognitively they can understand concrete examples of what is happening in their bodies as compared to relaxation training that may be more abstract. In a culture that provides video games, robots, computers, and other high-tech games and toys for children, they are usually attracted and eager to participate in the biofeedback session.

C. Clinical Issues in Using Biofeedback

Biofeedback can be abused if it used outside of the context of therapy. It cannot be used in the same manner that one would administer medication. Individual differences must be noted and addressed using an individualized protocol before biofeedback can be successful. Also, the individual should be closely monitored and changes recommended if problems arise. Biofeedback may be successful in the clinic, but patients may not be able to modify their responses in the natural environment without biofeedback. Thus the development of self-control should be included in the protocol.

Sometimes a person’s baseline physiological responses are normal, but the individual may experience exaggeration of SNS responses when stressed. Biofeedback should be focused on helping these individuals decrease SNS arousal during stressful situations. Thus, in biofeedback therapy it is important to teach biofeedback skills in a variety of situations and intensities of stimuli.

Biofeedback allows for discrete control of a response system. For example, one component of autonomic nervous system (ANS) activity can be modified without other ANS systems being called into play. Specific EEG patterns can be modified and discrete muscle groups as small as a single motor unit can be trained independently with the use of feedback. However, for the ANS it appears that increases in arousal-like activity are easier to obtain than decreases in arousal-like activity. Thus, researchers have more consistently demonstrated voluntary blood pressure and heart rate increases and skin temperature decreases than the opposite processes. This indicates that biofeedback may be more useful in lowering high levels of arousal such as those associated with clinical stress conditions or pathological states than normal or healthy states.

The specific form and structure of the biofeedback training must depend largely on the individual characteristics of the patient, the physiological symptoms in question, the particular physiological system for which feedback is to be given, the nature of the disorder itself, and the goals of treatment. Through an accumulation of knowledge gained through basic and clinical research, including systematic case studies, certain generalizations may be possible. However, at this time generalization are made with caution. The biofeedback clinician must choose a specific procedure on the basis of all the facts in the case and his or her own understanding of the current technology and state of research knowledge. The astute clinician can proceed in a systematic manner through trial, error, and close observation of clinical outcomes as they occur for a given patient.

Compliance to the biofeedback practice may be difficult at times as positive effects usually do not always happen instantaneously. The patient must be prepared to expect that decreases in symptoms may not occur for several weeks. Patient motivation may be low because for some disorders there are no short-term aversive consequences such as in hypertension. Another motivation reducer is that the symptom itself may be reinforced in the natural environment. The patient may experience secondary gain. For example, a patient may use talking about her problem in social situations to gain attention. What will she do in social situations if she does not have a problem to discuss? The patient may also be a candidate for social skills training, so that as the symptom is reduced she will have acquired other skills to help her cope in social situations. Another possible area of motivational difficulty may arise from other behaviors strongly entrenched in the patient’s repertoire that are in conflict with the aim of therapy. An example is a young man who has overextended himself in extracurricular activities and has poor time-management skills. This young man is quite able to learn the biofeedback skills but cannot find time to practice at home. This issue must be addressed by the therapist if treatment is to be successful.

If the patient is on medication that may effect the response that is being manipulated, consult with the patient’s physician to determine if the medication can be kept at a constant level while biofeedback therapy is occurring. If during the biofeedback training the patient or physician wants to decrease or increase medication intake, ask that this be reported so that this information can be used to evaluate the success of the biofeedback therapy.

VII. Opportunities in and Future of Biofeedback

A. Professional and Research Opportunities

Reports on studies of biofeedback have steadily declined over the past 10 years. This is unfortunate as there are still so many unanswered questions regarding how and why biofeedback works. The area of biofeedback research provides a wealth of opportunities, particularly as technology improves and instrumentation becomes more reliable and valid. There are now more training opportunities to learn biofeedback instrumentation and methodology. The Biofeedback Society of America encourages continued scientific investigations of biofeedback, and there are numerous high-quality scientific journals that publish biofeedback research, including Psychophysiology; Biofeedback and Self-Regulation; and Biofeedback and Behavioral Medicine.

On the professional level biofeedback techniques and therapy have become more widely accepted as a method of treatment for numerous mental and physical problems. Those interested in developing a profession in biofeedback can contact the two national societies, the Biofeedback Society of America and the American Association of Biofeedback Clinicians. There are also many state and regional biofeedback societies that provide training and scientific meetings.

B. Future Directions in Research, Clinical Practice, and Biofeedback Technology

Biofeedback is alive and well as there continues to be a steady output of high-quality research, greater acceptance of biofeedback as a clinical tool, and improvements in technology. Although biofeedback has been used to treat problems, it may have advantages in helping individuals develop self-regulation skills to prevent mental and physical health problems. For example, a study was reported in which children with no clinical problems were taught skin-temperature biofeedback. These children learned to relax and incorporated this in their daily schedule. They also demonstrated decreases in anxiety and depression scores, even though these scores were in the normal range. Biofeedback may have helped them achieve a greater degree of psychological health.

With the advent of greater access to personal computers people may be able to purchase inexpensive biofeedback devices that they can use at home to teach themselves self-regulation skills. Of course, as with all self-help approaches, misunderstanding of instructions, the problem, or proper follow-through may diminish the effectiveness of self-help biofeedback. However, combining home devices with some therapist assistance may be as effective as time-intensive, outpatient biofeedback training. These are just some of the future directions to be explored.

Bibliography:

  1. Andrasik, F. (1994). Twenty-five years in progress: Twenty-five more? Biofeedback and Self-Regulation, 19, 311–324.
  2. Miller, L. (1994). Biofeedback and behavioral medicine: treating the symptom, the syndrome, or the person? Psychotherapy, 31, 161–169.
  3. Schwartz, M. S. (1987). Biofeedback: A practitioner’s guide. New York: Guilford.
  4. Shapiro, D. (1977). A monologue on biofeedback and psychophysiology. Psychophysiology, 14, 213–227.
  5. Surwillo, W. W. (1990). Psychophysiology for clinical psychologists. Norwood, NJ: Ablex.

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