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Ask the Mental Health Expert Archives 2001-2004

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Biofeedback Techniques

Q. We are interested in biofeedback techniques. Specifcally, efficiency of biofeedback in managing anxiety disorders (e.g., social phobias). We would apreciate if you could provide any information/studies.

A. For those unfamiliar with biofeedback (BF), let's quickly explain that it is a technique by which certain autonomic functions (such as heart rate or blood pressure) are brought under voluntary control, usually by means of device that provides the patient with continuous feedback regarding the particular function. BF has been used to treat tension or migraine headaches, hypertension, and some anxiety disorders.

For example, Telch et al studied the use of heart-rate feedback in the emotional processing of claustrophobic fear. Nonclinical students (N = 54) showing marked claustrophobic fear received 30 min of self-directed exposure to a claustrophobic chamber. Three exposure conditions (heart-rate feedback, paced-tone control, and exposure only control) were examined across six 5-min exposure trials. Participants receiving heart-rate feedback displayed greater between-trial habituation across treatment trials and lower levels of fear at post-treatment. EEG biofeedback treatment of anxiety disorders is also an area of active investigation.

The basic idea is to enhance certain naturally-occurring brain wave rhythms by providing EEG feedback to the subject. Some data suggest that alpha, theta and alpha-theta enhancements are effective in the treatment of anxiety disorders (see Moore, Clin Electroencephalogr 2000 Jan;31(1):1-6). On the other hand, not all studies support EEG biofeedback's long-term effects. For example, Ossebaard examined the possible effects of two distinct brainmachine programs on burnout and anxiety (Appl Psychophysiol Biofeedback 2000 Jun;25(2):93-101). Subjects in both conditions showed a significant, immediate decrease in state anxiety as assessed by Spielberger's State-Trait Anxiety Inventory (STAI) and reported a range of subjective effects. However, a long-term effect on anxiety and burnout could not be established.

Finally, you may want to see the paper by E. Somer on Biofeedback-aided hypnotherapy for intractable phobic anxiety (Am J Clin Hypn 1995 Jan;37(3):54-64). My impression is that there are very few controlled studies comparing BF with other active treatment modalities (e.g., cognitive-behavioral therapy, anxiolytic medications, etc.) in the treatment of anxiety disorders. Thus, it's hard to comment on the efficiency or efficacy of BF for these conditions.

August 2001

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