Need information on biofeedback

how effective is it? what conditions is it used for? personal experiences?

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Biofeedback is a treatment technique in which people are trained to improve their health by using signals from their own bodies. Physical therapists use biofeedback to help stroke victims regain movement in paralyzed muscles. Psychologists use it to help tense and anxious clients learn to relax. Specialists in many different fields use biofeedback to help their patients cope with pain.

Chances are you have used biofeedback yourself. You've used it if you have ever taken your temperature or stepped on a scale. The thermometer tells you whether you're running a fever, the scale whether you've gained weight. Both devices "feed back" information about your body's condition. Armed with this information, you can take steps you've learned to improve the condition. When you're running a fever, you go to bed and drink plenty of fluids. When you've gained weight, you resolve to eat less and sometimes you do.

Clinicians reply on complicated biofeedback machines in somewhat the same way that you rely on your scale or thermometer. Their machines can detect a person's internal bodily functions with far greater sensitivity and precision than a person can alone. This information may be valuable. Both patients and therapists use it to gauge and direct the progress of treatment.

For patients, the biofeedback machine acts as a kind of sixth sense which allows them to "see" or "hear" activity inside their bodies. One commonly used type of machine, for example, picks up electrical signals in the muscles. It translates these signals into a form that patients can detect: It triggers a flashing light bulb, perhaps, or activates a beeper every time muscles grow more tense. If patients want to relax tense muscles, they try to slow down the flashing or beeping.

Like a pitcher learning to throw a ball across a home plate, the biofeedback trainee, in an attempt to improve a skill, monitors the performance. When a pitch is off the mark, the ballplayer adjusts the delivery so that he performs better the next time he tries. When the light flashes or the beeper beeps too often, the biofeedback trainee makes internal adjustments which alter the signals. The biofeedback therapist acts as a coach, standing at the sidelines setting goals and limits on what to expect and giving hints on how to improve performance.

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The Beginnings of Biofeedback

The word "biofeedback" was coined in the late 1960s to describe laboratory procedures then being used to train experimental research subjects to alter brain activity, blood pressure, heart rate, and other bodily functions that normally are not controlled voluntarily. At the time, many scientists looked forward to the day when biofeedback would give us a major degree of control over our bodies. They thought, for instance, that we might be able to "will" ourselves to be more creative by changing the patterns of our brainwaves. Some believed that biofeedback would one day make it possible to do away with drug treatments that often cause uncomfortable side effects in patients with high blood pressure and other serious conditions.

Today, most scientists agree that such high hopes were not realistic. Research has demonstrated that biofeedback can help in the treatment of many diseases and painful conditions. It has shown that we have more control over so-called involuntary bodily function than we once though possible. But it has also shown that nature limits the extent of such control. Scientists are now trying to determine just how much voluntary control we can exert.

How is Biofeedback Used Today?

Clinical biofeedback techniques that grew out of the early laboratory procedures are now widely used to treat an ever-lengthening list of conditions. These include:

Migraine headaches, tension headaches, and many other types of pain
Disorders of the digestive system
High blood pressure and its opposite, low blood pressure
Cardiac arrhythmias (abnormalities, sometimes dangerous, in the rhythm of the heartbeat)
Raynaud's disease (a circulatory disorder that causes uncomfortably cold hands)
Paralysis and other movement disorders
Specialists who provide biofeedback training range from psychiatrists and psychologists to dentists, internists, nurses, and physical therapists. Most rely on many other techniques in addition to biofeedback. Patients usually are taught some form of relaxation exercise. Some learn to identify the circumstances that trigger their symptoms. They may also be taught how to avoid or cope with these stressful events. Most are encouraged to change their habits, and some are trained in special techniques for gaining such self-control. Biofeedback is not magic. It cannot cure disease or by itself make a person healthy. It is a tool, one of many available to health care professionals. It reminds physicians that behavior, thoughts, and feelings profoundly influence physical health. And it helps both patients and doctors understand that they must work together as a team.

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Patients' Responsibilities

Biofeedback places unusual demands on patients. They must examine their day-to-day lives to learn if they may be contributing to their own distress. They must recognize that they can, by their own efforts, remedy some physical ailments. They must commit themselves to practicing biofeedback or relaxation exercises every day. They must change bad habits, even ease up on some good ones. Most important, they must accept much of the responsibility for maintaining their own health.

How Does Biofeedback Work?

Scientists cannot yet explain how biofeedback works. Most patients who benefit from biofeedback are trained to relax and modify their behavior. Most scientists believe that relaxation is a key component in biofeedback treatment of many disorders, particularly those brought on or made worse by stress. Their reasoning is based on what is known about the effects of stress on the body. In brief, the argument goes like this: Stressful events produce strong emotions, which arouse certain physical responses. Many of these responses are controlled by the sympathetic nervous system, the network of nerve tissues that helps prepare the body to meet emergencies by "flight or fight."

The typical pattern of response to emergencies probably emerged during the time when all humans faced mostly physical threats. Although the "threats" we now live with are seldom physical, the body reacts as if they were: The pupils dilate to let in more light. Sweat pours out, reducing the chance of skin cuts. Blood vessels near the skin contract to reduce bleeding, while those in the brain and muscles dilate to increase the oxygen supply. The gastrointestinal tract, including the stomach and intestines, slows down to reduce the energy expensed in digestion. The heart beats faster, and blood pressure rises. Normally, people calm down when a stressful event is over especially if they have done something to cope with it. For instance, imagine your own reactions if you're walking down a dark street and hear someone running toward you. You get scared. Your body prepared you to ward off an attacker or run fast enough to get away. When you do escape, you gradually relax.

If you get angry at your boss, it's a different matter. Your body may prepare to fight. But since you want to keep your job, you try to ignore the angry feelings. Similarly, if on the way home you get stalled in traffic, there's nothing you can do to get away. These situations can literally may you sick. Your body has prepared for action, but you cannot act. Individuals differ in the way they respond to stress. In some, one function, such as blood pressure, becomes more active while others remain normal. Many experts believe that these individual physical responses to stress can become habitual. When the body is repeatedly aroused, one or more functions may become permanently overactive. Actual damage to bodily tissues may eventually result.

Biofeedback is often aimed at changing habitual reactions to stress that can cause pain or disease. Many clinicians believe that some of their patients and clients have forgotten how to relax. Feedback of physical responses such as skin temperature and muscle tension provides information to help patients recognize a relaxed state. The feedback signal may also act as a kind of reward for reducing tension. It's like a piano teacher whose frown turns to a smile when a young musician finally plays a tune properly.

The value of a feedback signal as information and reward may be even greater in the treatment of patients with paralyzed or spastic muscles. With these patients, biofeedback seems to be primarily a form of skill training like learning to pitch a ball. Instead of watching the ball, the patient watches the machine, which monitors activity in the affected muscle. Stroke victims with paralyzed arms and legs, for example, see that some part of their affected limbs remains active. The signal from the biofeedback machine proves it. This signal can guide the exercises that help patients regain use of their limbs. Perhaps just as important, the feedback convinces patients that the limbs are still alive. This reassurance often encourages them to continue their efforts.

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Should You Try Biofeedback?

If you think you might benefit from biofeedback training, you should discuss it with your physician or other health care professional, who may wish to conduct tests to make certain that your condition does not require conventional medical treatment first. Responsible biofeedback therapists will not treat you for headaches, hypertension, or most disorders until you have had a thorough physical examination. Some require neurological tests as well.

How do you find a biofeedback therapist? First, ask your doctor or dentist, or contact the nearest community health center, medical society, or State biofeedback society for a referral. The psychology or psychiatry departments at nearby universities may also be able to help you. Most experts recommend that you consult only a health care professional a physician, psychologist, psychiatrist, nurse, social worker, dentist, physical therapist, for example who has been trained to use biofeedback.

The Association for Applied Psychophysiology and Biofeedback (formerly the Biofeedback Society of America)
10200 W. 44th Avenue
Suite 304
Wheat Ridge, CO 80033-2840
Phone: 1-800-477-8892 / 303-422-8436
Fax: 303-422-8894

AAPB is the national membership association for professionals using biofeedback. AAPB holds a national meeting, offers CE programs, produces a journal and newsmagazine and other biofeedback related publications.

The Biofeedback Certification Institute of America
10200 W. 44th Avenue
Suite 304
Wheat Ridge, CO 80033-2840

The BCIA was established as an independent agency to provide national certification for biofeedback providers.

This Material Was provided through:
U.S. Department of Health and Human Services
Division of Communications and Education, National Institute of Mental Health
Public Health Service - Alcohol, Drug Abuse and Mental Health Administration
5600 Fishers Lane
Rockville, MD 20857 USA

What is Neurofeedback? Client's Guide to Neurotherapy

Welcome to the World of Neurotherapy
We appreciate your interest in Neurotherapy, a promising treatment for Attention-Deficit/ Hyperactivity Disorder. The purpose of this guide is to tell you about the Neurotherapy process and how to find a practitioner who can provide this kind of service for you or a member of your family. Please read this guide and wrote down any questions you have. These questions can be answered by calling a practitioner who provides Neurotherapy services or by calling one of the resources listed later in this guide.

What is Attention-Deficit Disorder?

Attention-Deficit Disorder is a disorder that can be separated into three types: 1) Attention-Deficit/Hyperactivity Disorder, Combined Type (includes both symptoms of inattention and hyperactivity-impulsivity), 2) Predominantly Inattentive Type (sometimes referred to as ADD) and 3) Predominantly Hyperactive-Impulsive Type (sometimes referred to as ADHD or Hyperactivity Disorder).

Individuals with Attention-Deficit/Hyperactivity Disorder, Combined Type have six or more symptoms of inattention and six or more symptoms of hyperactivity-impulsivity that have been present for six or more months (see sections that follow for sample symptoms).

Individuals with Attention-Deficit Disorder, Predominantly Inattentive Type (ADD) exhibit six or more symptoms of inattention and less than six symptoms of hyperactivity-impulsivity. They usually exhibit some of the following symptoms: inattention, distractibility, disorganization, daydreaming, lack of foresight, carelessness, forgetfulness, lack of motivation, lack of persistence, and procrastination.

Individuals with Attention-Deficit Disorder, Predominantly Hyperactive-Impulsive Type (ADHD) usually exhibit six or more symptoms of hyperactivity-impulsivity and less than six symptoms of inattention. They usually exhibit some of the following symptoms: hyperactivity, fidgeting behavior, restlessness, excessive talking, inappropriate running and climbing, often "on the go," can't wait turn, interrupt others, and impulsive.

Many individuals display symptoms that can be included under any of the three types of attention-deficit disorder. Individuals with an Attention-Deficit Disorder, e.g., ADD or ADHD often have significant difficulties with learning, concentration, school or job achievement, behavior control, social relationships, and self-esteem. Further, Attention-Deficit Disorders are often associated with other disorders, such as Learning Disorders, Oppositional and Conduct Disorders, Tourette's, Anxiety, and Depression. Neurotherapy can be used to treat individuals with all three types of attention-deficit disorders, as well as some of the associated disorders.

How Do I Know IF I or my Child Has ADD/ADHD?

If an individual has many of the symptoms specified in the previous section, then that individual might have ADD or ADHD. To determine whether a diagnosis of ADD or ADHD is appropriate, the individual should be diagnosed through a thorough evaluation conducted by professionals who are familiar with the disorder. Your family physician, a pediatrician, psychiatrist or psychologist may be able to conduct the appropriate assessment to determine if such a diagnosis is appropriate or refer you to someone who can make the diagnosis.

What Is Neurotherapy?

Neurotherapy is also called "EEG Biofeedback" and "Neurofeedback." It involves helping a person learn how to modify his or her brainwave activity to improve attention, reduce impulsivity, and to control hyperactive behaviors. It is a painless, non-invasive treatment approach that allows the individual to gain information about his or her brainwave activity and use that information to produce changes in brainwave activity. Available research indicates that individuals with ADD/ADHD have too little of certain types of brainwave activity in some areas of the brain and/or too much of certain other brainwave activity in comparison to those without the disorder. In Neurotherapy individuals are trained through the use of computerized biofeedback equipment to change their brainwave activity.

Clinicians and researchers who have provided Neurotherapy training report that when brainwave activity is changed, or when the brain is trained to work in certain ways in the process of Neurotherapy, symptoms of ADD/ADHD are usually reduced.

How Is Neurotherapy Performed?

Brainwave activity is measured with an electroencephalograph (EEG). The EEG Biofeedback equipment is connected to the individual with sensors that are placed on the scalp and ears. The sensors are safe, do not prick the skin, and are painless. After adequate connection to the scalp and ears are made, the individual's brainwave activity can be observed on a computer monitor.

Neurotherapy practitioners who administer Neurotherapy will help the client learn to change his or her brainwave activity. The client does not need to know a lot about Neurotherapy or biofeedback to be effectively trained. Clients are taught to play computerized games using their brainwave activity. Changes in client brainwave activity are fed back to the individual through visual and/or auditory information by the computer. One example is a game where clients move a figure through a maze (similar to the popular pac-man game). The figure does not move because of the client's motor activity (e.g., pushing a button or moving a stick). Instead, the figure moves whenever the client produces specific brainwave patterns. When desired levels of brainwave activity occur, the individual is reinforced, because the figure moves through the maze. By this method, clients learn to change brainwave activity. Clients also practice maintaining learned brainwave states when engaged in school- or work-related tasks (e.g., reading, writing). This will help them use what they learned in Neurotherapy in their daily activities.

What Results Are Expected from Neurotherapy?

Through changes in brainwave activity, reductions in ADD/ADHD symptoms are expected to occur. Individuals who have received Neurotherapy have also reported improvements in school or work performance, social relationships, and self-esteem, as well as reduction in irritability and oppositional behavior. Neurotherapy practitioners will use various assessment instruments to determine whether the desired changes in brainwave activity and/or behavior have occurred.

Individuals should be aware that Neurotherapy can have a significant effect on seizure activity of those with seizure disorders. This effect, however, is usually positive (i.e., a reduction in seizures).

While you should not experience negative side-effects from Neurotherapy, you may experience additional benefits. Some individuals report increased relaxation, reduced stress, and a heightened sense of control over their bodies, thoughts, and feelings during or immediately after treatment sessions.

How Successful Is Neurotherapy?

Some clinicians and researchers have reported remarkable success in the treatment of ADD/ADHD with Neurotherapy. Others still consider Neurotherapy to be an experimental procedure. Several research studies reporting successful treatment outcomes with ADD/ADHD have been published over the last 20 years. In addition, there are increasing numbers of clinician reports being added to computerized data bases that attest to the effectiveness of Neurotherapy as a treatment for ADD/ADHD. However, more research on the effectiveness of Neurotherapy in the treatment of ADD/ADHD is still needed.

The client should know in advance that, as with all treatments, positive results (i.e., reductions in ADD/ADHD symptoms) cannot be guaranteed.

Some major reasons why practitioners are committed to providing Neurotherapy are: to attempt to help individuals for whom other approaches have failed, to help individuals who do not want to use medications for years, and to add to the scientific evidence related to Neurotherapy's use.

What Are the Potential Side-Effects of Neurotherapy?

Unlike the use of medications for treating ADD/ADHD, Neurotherapy rarely produces negative side-effects. In fact, lack of side-effects is a major reason for the use of Neurotherapy. To learn more about reported side-effects, you may want to ask a practitioner who provides Neurotherapy treatment. Some potential side effects are discussed below.

To reduce electrical impedance and to ensure cleanliness and safety, the client's skin is cleaned on the areas where the EEG sensors are applied. Some individuals with sensitive skin may experience small breaks in the skin when the cleaning occurs.

A very, very small minority of individuals have reported brief periods of negative feelings (e.g., anxiety, or frustration) or negative physical sensations (e.g., fatigue, dizziness, tingling sensations) while undergoing treatment. These negative side-effects are very rare and usually last for only a short period of time.

Some families experience a disruption in family roles and relationships after the family member who has received Neurotherapy training gets better. The problem behaviors of the family member with ADD/ADHD may have masked other family problems that come into the spotlight once the ADD/ADHD symptoms are reduced. The anxiety levels of family members may increase, because they have been used to focusing on one problem and now must focus on a new one.

How Long Will Neurotherapy Last?

During Neurotherapy, you or your family member will be learning to change and control brainwave patterns. This learning process takes time. The length of treatment varies between individuals. Many individuals report initial progress after ten sessions, but effective treatment usually requires between twenty and forty 40 sessions. Clients will be asked to participate in enough sessions to ensure that treatment produces the changes in behavior desired or to make clear that the intervention does not seem to be working for a particular client.

How Frequently Will Neurotherapy Sessions Occur?

The number of sessions of treatment received per week varies based on time available, transportation issues, finances, progress, and individual preferences. Neurotherapy has been reported to be effective when sessions are received daily, three times per week, twice per week and once per week. To assure progress, it is recommended that clients receive at least one session per week of Neurotherapy. In the initial stages of training, many practitioners prefer that sessions occur frequently (e.g., two to three times per week). As learning and progress take place, sessions are usually reduced to once per week and finally to one or two sessions per month.

Who Will Provide Neurotherapy?

Neurotherapy should be administered by a practitioner trained in the use of EEG equipment, who has the background knowledge about ADD/ADHD and Neurotherapy needed to provide neurofeedback, who has extensive experience, or who is practicing under the supervision of a qualified practitioner.

How Do My Family Member(s) or I Begin Neurotherapy?

To begin you will need to find a practitioner competent to provide Neurotherapy services.

Care should be taken in selecting a practitioner. The two most commonly used criteria for finding a competent practitioner are to look for someone who is certified in the use of EEG Biofeedback, someone who is licensed as a health care practitioner and who does Neurotherapy, or someone who is both certified and licensed.

To find a practitioner who has been certified to do EEG Biofeedback, you can contact The Biofeedback Certification Institute of America 10200 West 44th Avenue, Suite 310 Wheat Ridge, CO 80033-2840 Phone: 303-420-2902 Email: Fax: 303-422-8894. Searchable practitioner listings are available on their web site at

To find a practitioner you can also go to the Yellow pages of your telephone directory and look under biofeedback and/or under the titles of health care professionals (such as: psychologists, professional counselors, social workers, etc.) to see if anyone is listed who does Neurotherapy/Neurofeedback/EEG Biofeedback. If so you can contact them by phone and see if they do Neurotherapy, to make an appointment, or to learn more about what they do.

What Is the Course of Neurotherapy?

In the first appointment the practitioner will conduct a background interview to ascertain the history of the person who is suspected to have or who has been previously diagnosed with ADD/ADHD. He or she will also answer any questions you have.

During the first or second appointment(s), the practitioner will also conduct an evaluation of the client. This evaluation may well include a number of individual tests (e.g., EEG examination, intelligence tests, neuropsychology tests of attention and concentration, tests of academic abilities, etc.) that will be administered to the client as well as some checklists that the client and/or parents and teachers will be asked to complete. The evaluation will have a number of purposes, including: 1) to determine whether the client has ADD/ADHD (or confirm a previous diagnosis); 2) to determine whether there are coexisting problems which need to be addressed; and, 3) to establish a baseline of behaviors so that, during and after the course of treatment, the practitioner and you can objectively determine whether progress (e.g., reduction of ADD/ADHD symptoms, improvement in school or job performance) is or has been made.

After the evaluation, Neurotherapy sessions begin. Over the course of the Neurotherapy treatment, the client and/or parents will be administered some tests and asked to answer questions about progress at home, school, or work. Releases may need to be signed to allow the practitioner to interact with other professionals (e.g., school teachers) who are involved in the client's life or who have information about the client's performance and behavior in other locations. After the Neurotherapy sessions have ended, a final evaluation will occur. The reason for periodic evaluations of the client during the Neurotherapy process is to determine whether improvement is occurring in important areas of the client's life and to adjust the treatment program as appropriate.

You may be asked to sign a consent form to allow the practitioner to use the data collected during the Neurotherapy process for research purposes. The name of the client (and/or parents) will remain confidential. The data collected from the individual will only be reported in relationship to data collected from other individuals. No names will ever be mentioned in reporting research data.

Concurrent Use of Neurotherapy and Medication

Patients and their parents commonly ask if medications and Neurotherapy can be provided at the same time. Generally, the answer is yes. The correct dosage of stimulant medications (e.g., Ritalin, Adderall, Dexedrine, or Cylert) can, when effective, produce a rapid reduction in the frequency of impulsive and hyperactive behaviors. As such, many patients will start a trial of medications or be on medications when they start receiving Neurotherapy.

Over the course of treatment, individuals using medications may be able to reduce or terminate the use of these medications while maintaining control over disruptive behaviors. However, any changes in medications must be discussed with the prescribing physician. The physician and family together will decide whether a reduction in medications is appropriate.

What Is the Cost of Neurotherapy Assessment and Treatment?

The cost for Neurotherapy varies from area to area and practitioner to practitioner. Talk to your practitioner about the number of sessions, cost of each session, cost of evaluations and other issues involved in your treatment.

Will My Insurance Company Cover the Costs of Neurotherapy for ADD/ADHD?

Neurotherapy is still considered to be a relatively new treatment for ADD/ADHD even though it has been in use for more than 20 years. Some insurance companies do provide coverage while others do not; however, many companies cover assessment for ADD/ADHD even if Neurotherapy treatment is not covered. You are encouraged to contact your insurance company, before your initial appointment, to find out whether your policy covers assessment and/or Neurotherapy treatment for ADD or ADHD. When discussing Neurotherapy with your carrier, remember that Neurotherapy has also been called "EEG Biofeedback" and "Neurofeedback."

See also Facts About Biofeedback For Insurance Decision Makers, an AAPB Information Paper you can show your insurance provider to encourage them to cover your neurotherapy.

How Are Payments Made?

When payments are made also varies from practitioner to practitioner. Some require payments to be made before each session (including assessment session), some expect payment at the end of the session and some have other expectations. The best way to proceed is to ask a practitioner about costs, billing, payment expectations, help with filing insurance claims, what his or her policy policies about payment are, and to work out a payment schedule. Unless verification has been received that the insurance company will pay, most practitioners will expect some or full payment at the time of each session. If payment is not received then treatment cannot be provided. Interruptions in treatment may result in delayed progress and a need for additional treatment sessions. If insurance covers part of the cost of each session, the client must pay the other part of the costs.

About Confidentiality

All information shared with the practitioner and all data collected is confidential to the degree specified in the limits of confidentiality that will be discussed with you or included in a document that you will be asked to sign. The practitioner can explain to you the legal and ethical limits that require sharing certain information with others, e.g., all practitioners are required to report suspected child abuse or neglect.

About Appointments

By scheduling an appointment with you, a practitioner has reserved a room, computerized equipment, and a staff professional's time for you. Please come to sessions on time. We suggest that you arrive five to 10 minutes early to avoid the rush of finding a parking space. Should you need to cancel an appointment, please give the practitioner as much notice as you can and no less than a 24-hour notice, as most practitioners can rarely fill a canceled appointment in less than that amount of time. Many practitioners will bill clients for cancellations which do not occur at least 24 hours before the session. Your practitioner should explain his or her cancellation policy to you.

Will I Be Required to Sign Anything to Receive Neurotherapy?

At your first appointment, the practitioner will probably ask you to sign a number of forms which will allow her or him to provide the best possible services to you. You will have the opportunity to review these forms and the practitioner should be available to answer any questions that you might have.

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