Biology 202
1998 Third Web Reports
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Mind Over Matter: The use of Biofeedback to control stress, pain, and other bothersome problems

Katie Cecil

Having a bad day? Well, I am. I have too much work to do, like always, but I want and have to graduate. I think I'm happy about that, about putting an end to all the pressure I have felt in these last four years. Then again I am not sure what to think. I will miss my friends, especially all those people with whom I was briefly acquainted and liked enough to sense the possibility of friendship but will never know now. On top of these worries are more general fears of the uncertainty of the next few years, not to mention the rest of my life. Going home to a place I've never really liked simply because I can't think of anything better to do scares me; the possibility of getting stuck there scares me even more. I need to find a job. I need to find a career. I want to go to graduate school at some point, but my grades after this semester will not make admission easy. Needless to say, there is a lot on my mind. This morning I went in for a doctor's appointment, just a quick check-up because I've been sick. As is routine, the nurse took my blood pressure. Then she turned and frowned at me. Seems that the pressure I'm under is not just weighing down on my mind. My body is responding to my higher level worries by sending my blood slamming through me with alarming force. We like to think of stress as a purely higher level function which only effects us on that level, and generally ignore the effects it might have on us on a more biological as opposed to psychological level, i.e. on the level of our voluntary and autonomic response systems. We hear Doctors on TV and DJs on NPR warning us that stress can kill, but we disregard them until we see a nurse frown at us in disapproval. If it can have such negative effects on our body, why then do we experience stress? The stress response is defined as: "a set of changes in the body that result when the person experiences what they perceive to be a challenging or threatening situation." Physiological changes which may occur as the result of a stress response may include:

* Increased blood pressure
* Increased respiratory rate
* Increased heart rate
* Increased oxygen consumption
* Increased blood flow to skeletal muscles
* Increased perspiration
* Increased muscle tone (4)

These changes are related to what has long been know as the fight-or-flight reaction of the body. (2) When one finds oneself in what is perceived as a threatening situation, oneŐs body response to the strong emotions being produced by preparing the body to function at a higher level of efficiency in hopes of increasing the likelihood of survival. Scientists consider this reaction to be quite primitive, relating back to a time when survival depended more on response to external stimuli as opposed to internal processing of a situation. If one spotted a bear, such a stress reaction would be ideal to help her run away. Then, once she was safe, she experienced relief. Unfortunately in today's world, stressors, being very much internalized, are virtually the opposite of those experienced by our ancestors, whose life expectancy was around twenty years. (1) Thus today, when one experiences anger as the result of a disagreement with a professor but fears the result of a confrontation on her grade, the body prepares to fight but finds no outlet for these emotions and subsequent physical reactions. To increase light, pupils dilate. To reduce the chance of cuts, sweating increases. Near the skin, blood vessels contract to reduce bleeding, but dilate in the brain and muscles to increase the transfer of oxygen. The gastrointestinal tract slows in an attempt to conserve energy that would otherwise have been expended in digestion. Heart rate increases and blood pressure rises. (2) But unlike a situation from which one can escape, for most modern situations there is no relief. Thus as a result of consistent unrelievable stress responses, many scientists believe that we have forgotten how to relax and this lack of relaxation can cause serious problems for both our mental and physical health. (2) If higher level functions of the mind can affect autonomic functions of the body, cannot the body also be controlled by mind? For years it was thought that controlling physiological responses, such as heart rate or vascular responses, was impossible. (3) Nevertheless, beginning in the 1940s, experiments concerning the control of brain activity, blood pressure, muscle tension, heart rate and other bodily functions began in the labs of Neal E. Miller. (5,6,9) Throughout the 50s, then increasing in the 60s, the results of experimentation, mostly on animals although some studies were done on humans, began to suggest more and more that it is, in fact, possible to regulate some physiological responses. (9) Then in 1969 the term 'biofeedback' was first coined by the Biofeedback society of America. (1,2,3,5,6) The Grolier Encyclopedia defines Biofeedback as: "a method for learned control of physiological responses of the body." (9) At that time, scientists were talking as though biofeedback would change the world. (3) Some researchers went so far as to put forth the hope that, through biofeedback, people would one day be able to increase their level of creativity simply by willing themselves to change the patterns of their brain waves. Others thought biofeedback would replace drug treatments for those suffering from high blood pressure or other serious conditions. (2) Needless to say, such dreams were a bit grandiose. Nevertheless, in the last three decades since the term 'biofeedback' was first used, the some 100 books and 3,000 articles written on the topic of biofeedback argue that it is an interesting and effective means of treating, or complementing treatment of, many common ailments. Biofeedback training is defined as: "the presentation of information, such as heart rate, usually by means of meters, lights, or auditory signals, so that the subject can become better away of inside-the-skin behaviors," and thus "learn how to self-regulate the biological process being displayed."(1) Clinical biofeedback procedures are used in treating an ever increasing number of physiological and psychological ailments. These include: Physiological Problems (2,3,10):

* Migraine and tension headaches
* Disorders of the digestive system
* High blood pressures, as well as low blood pressure
*Cardiac arrhythmia
* RaynaudŐs disease
* Epilepsy
* Paralysis and other movement disorders
* Asthma
* Menopausal hot flashes
* Incontinence: Fecal and Urinary
* Motion sickness
* Myofascial pain
* Rheumatic Arthritis Pain

Psychological Problems (2,3,10):

* drug and alcohol abuse
* anxiety
* post-traumatic stress disorder
* depression
* multiple personality disorders
* panic disorders
* eating disorders

Researchers have yet to determine the exact processes by which biofeedback works, but even without establishing a precise etiology, the field of biofeedback developed a wide variety of interesting and effective treatments. (2)

The instruments most commonly employed in biofeedback training are used to determine muscle tension (Electromyography [EM] feedback), skin temperature (thermal feedback), brain waves (Electroencephalograph [EEG] feedback), perspiration (Galvanic skin response [GSR] feedback), and respiration. By monitoring the feedback given by these machines, subjects attempt to adjust their thinking and their conscious mental processes in a manner which will alter the output of the bio-rhythm measured by the machine to a more desirable. (3) Brain information from these different measures is presented to the subject in two ways: binary and/or analog fashion. The binary method employs a positive feedback loop. A threshold is established, and when it is crossed, a light or tone sounds to inform the subject of his or her success. An analog approach allows the patient to monitor the actual numbers reported by the machine in use. These two procedures are often combined. (6,9) Thus the patient continues to use machines until he or she begins to learn to recognize and control his or her voluntary or autonomic responses on his or her own without the help of the instruments. (1, 2, 3, 5, 6, 7, 9)

Temperature biofeedback monitors the increase of blood flow to the fingers and the resulting raise in finger temperature. Blood flow to the hands is a good measure of stress and relaxation, and monitoring the subsequent increase and decrease of temperature provides information on thoughts paralleled or associated with relaxation. This method of therapy is used in treatment of specific vascular disease such as migraine headache, RaynauldŐs disease, hypertension, etc. The EMG provides a measure of muscle tension by placing monitors over certain areas of muscle. This method provides treatment for tension headache and pain reduction. Moreover, it has worked virtual miracles on problems with muscle spasm or paralysis resulting from injury or stroke (5, 8). GSR feedback measures the amount of perspiration produced in response to certain emotions, thoughts, and/or situations. This method allows subjects to recognize and thus better control their response through the desensitization of emotive stimuli. Thereby it is used to treat anxiety and panic disorders. Finally, by placing sensors on the scalp, the EEG gives a generalized picture of different levels of brain wave activity, fluctuations of which reflect sleep vs. wake or level of attention/arousal. Use of an EEG in biofeedback training is utilized in the improving control of relaxation. It has also been used to aid in the treatment of pain, insomnia, hyperactivity and attention problems, and drug and/or alcohol addiction. (8)

One of the most talked about areas of research in biofeedback today involves alpha-theta brainwave training. (3) Brainwaves, as displayed by an EEG, show four fundamental patterns:

* Beta Waves: 13-30 Hz Alert state
* Alpha Waves: 8-12 Hz Relaxed wakefulness
* Theta Waves: 4-7 Hz Reverie, imagery
* Delta Waves: 0.5-3 Hz Deep sleep

By the 1930s, researchers had determined that repetitive light stimulation, or strobing, could regulate and synchronize the rate at which brainwaves occurred. Moving from Beta Waves to the level of Alpha or Theta waves should produces a state of very pleasant relaxation.(7) If one is able to properly relax, often times one can think more clearly and the worlds stressors seem a bit more manageable. Thus it is thought that this type of biofeedback could be very effective in the treatment of various mental disorders such as chemical dependence, post-traumatic stress disorder, depression, anxiety, multiple personality, panic and eating disorders. Although such research is only in its infancy, early studies on chronic alcoholics is very promising. Learning to increase lower frequency alpha and theta waves and better regulate the higher frequency beta waves appears to reduce craving for alcohol and decrease relapse rate in recovering alcoholics. For example, Peniston and Kulkosky (1989, 1990, 1991) developed a battery of treatment which included 6-8 weeks of thermal biofeedback and autogenic training, followed by 30 sessions of alpha-theta EEG biofeedback involving an emphasis on mental imagery which included positive personal change. Early results of this method are impressive, showing 80% effectiveness in decreasing not only alcoholic behaviors, but also many of the dysfunctional personality factors which contribute to the disease on a more indirect level. Even blood chemistry appears to be affected as levels of beta-endorphin hormones, which produce pleasure and decrease pain, increase in subjects treated with alpha-theta brain wave training. While the long term effectiveness of this form of treatment is not yet known, early studies are very encouraging for the treatment of alcoholism, and will hopefully be equally effective for other mental disorders. (3) The results of using biofeedback to treat or compliment the treatment of many other disorders are also very positive. People employing the techniques for treating tension or migraine headaches report success even after 15 years have passed since the beginning of treatment, and the American Association of Headaches lists biofeedback as an effective means of treatment. Moreover, biofeedback is the primary treatment of urinary incontinence, a problem very common in the geriatric population, as well as in those who have multiple sclerosis, muscular dystrophy, prostrate surgery, or a stroke. As much as 90% of children under twelve year of age experiencing sleeping problems such as bed wetting recover within the first two months of treatment. Furthermore, in one study 80% of persons with essential hypertension were able to reduce or go without the medication prescribed for their condition. In ADD/ADHD children, studies report positive results in 60-80% of patients who use biofeedback techniques. (5) By providing an excellent means of determining which muscles need to be exercised, even stroke victims report regaining control of formerly paralyzed limbs.(2) Such success stories no doubt contribute to the reasons that the use of biofeedback and other such mind/body treatments almost equals that of more traditional externally controlled treatments, according to The New England Journal of Medicine. (5)

Personally my first reaction, when reading about the use of biofeedback and other mind/body approaches in treating physical disorders, was to write off the whole business as one large placebo effect. Then the more I read the more I realized how correct I am in my interpretation, but now I realize that biofeedback is not simply the result of random positive effects of some belief or suggestion accidentally instilled in the test subject. Rather, I now believe that biofeedback may actually be one means of consciously and effectively harnessing the incredible power of the placebo effect. Indeed, the Latin translation of the word "placebo" is "I shall please." (4) If nothing else, biofeedback is a harmless alternative or complement to many more traditional means of treating a multitude of ailments. The brain is an amazing thing, the power of which should never be discounted. Research on biofeedback is both a fascinating area of study and promise of a more complete understanding of just what our minds can do. Perhaps the nurseŐs frown is a needed wake up call. I may feel like my life is out of control, but the one thing I always do is think positive. It will not only improve my mental state, but my physical well being as well. Besides, things are looking up; I've just finished another paper.


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