Biofeedback, Learning to Control your Body Against Pain and Anxiety by Dr. Bruce Levine
Most people have heard of "biofeedback" but don't really know what it is, how it works or why it might be useful in chronic pain disorders. Let's consider that “biofeedback” includes "bio" (biological functions of the body, mostly those that are not in our conscious awareness such as blood flow, heart rate, brain waves, or muscle contraction levels) while "feedback" is information within our awareness about the levels of these biological functions. Biofeedback is a method for monitoring and measuring biological reactions of our bodies and then making those reactions known to us consciously in the form of "feedback."
An example: a device might monitor to record the temperature of a part of our body that is affected by the amount of blood flowing there—the more blood flow, the warmer that part. Normally, we exert no conscious control over blood flow or its effect on the warmth of any body part. However, with biofeedback therapy, we can become aware of very small changes in temperature and thus become aware of the blood flow that causes the changes in temperature.
Why is this of any importance? Because receiving feedback about changes going on inside our bodies allows us to gain conscious control over these functions!
That's right, if you could become consciously aware of even slight changes in the temperature of a part of your body, then you could learn to control (voluntarily and consciously) the temperature of that area by achieving the astounding ability to alter blood flow to it.
So, even if you could learn to alter your skin temperature, why would you want to and how might this be related to chronic pain or anxiety disorders? First, in regard to pain disorders, let's say you suffer from chronic pain due to abnormal blood flow like Reynaud's Disease (pain related to ice-cold hands or feet), CRPS (where decreased blood flow to some body parts often causes numbness and/or pain), or Migraine Headaches. Imagine for a moment how chronic pain disorders such as these might be impacted if you could actually learn to either direct or re-direct blood flow towards or away from the painful area, thus warming or cooling that area?
Biofeedback methods offer such a promise. By receiving sound or visual feedback that is directly correlated with slight changes in temperature (or muscle contraction levels, heart rate, etc) the patient begins to acquire the ability to control these biological functions and their impact on the pain associated with these effects.
People with chronic pain disorders react to the pain, of course, with both emotional (fear, anxiety) and physical (heightened physiological responding) impact. Psychologists refer to this as a "stress reaction" known more commonly as "The Flight or Fight Response." It is the automatic, innate and protective response that we all have to any signals that suggest danger and are responses that also occur when people suffer from anxiety disorders. Of course, this response's major useful role in our lives is to signal us when something is wrong – when we are in danger. But in anxiety disorders the same automatic responses that occur during the "Fight or Flight Response" occur even when there is no imminent danger.
When the part of the brain (called the "sympathetic nervous system") that responds to danger is activated by the perception of danger, all sorts of automatic and normally protective reactions are set into motion. The heart rate goesup to move blood more quickly to areas that need oxygen and glucose. The Pupils dilate (to allow more light to enter the eye), and perspiration increases to help cool down the body during fight or flight. Muscle contraction also increases to allow one to "spring" into action for defense or flight. Blood flow then moves away from the fingers and feet and towards the internal organs. Thus the phrase "they got cold feet" when referring to people who make a decision to avoid something perceived as dangerous. Additionally, the intestines speed up their movement of food so that more glucose can be extracted as increased energy needs to be expended during fight or flight.
This is all great and helpful if one is actually in danger. But when this cascade of reactions occur in response to events that are not really dangerous, it can paradoxically make the patient's symptoms even worse. During a "panic attack" for instance, the same set of automatic physical reactions are triggered by imagined danger, by subtle stimuli in the environment or even thoughts that seem dangerous.
Therefore, one of the other potential benefits of biofeedback therapy could be to reduce the activation of the sympathetic nervous system, thereby limiting or reversing the arousal of these reactions linked to fear and danger.
You are probably asking yourself how this is done exactly. Well, biofeedback is a method of treatment that is painless and involves no pins, needles, shocks or any discomfort. Depending upon the physiological response that is being trained, a small sensor is placed on the body (e.g. a tiny thermometer may be attached to the finger or a small muscle sensor attached to the forehead) and the information is routed to a machine that measures slight changes in the response being treated. The person is either shown a visual display or provided with headphones through which some pleasant sound is relayed (e.g. music).
When the patient makes a slight alteration in the response (increases finger temperature or decreases muscle contraction level) they get immediate visual or auditory "feedback" telling them of their success. So, if they are being trained to raise their finger temperature for instance, every time the temperature rises 1/100 of a degree they are reinforced by hearing music or seeing changes on a visual display!
Through this repeated feedback, they learn to control responses not normally under their control, in a direction opposite that occurring when autonomic sympathetic arousal arises. Viola!…..they begin to produce physiological responses more similar to what happens when they are relaxed, rather than what happens when they experience "fight or flight" type reactions.
Finding a psychologist who is also qualified to provide this type of treatment is fairly easy. The Biofeedback Certification International Alliance (BCIA) is the largest non-profit organization that credentials providers in this field and provides the public with a list of Board-Certified providers in their geographic area. To access their search site, simply direct your browser to: BCIA Board Certified Practitioner and Mentor Directory.
Bruce A. Levine, Ph.D., ABPP, BCIA
Board Certified in Clinical Psychology & Biofeedback
Clinical Psychologist & Biofeedback Therapist,
David Geffen School of Medicine at UCLA
Pediatric Pain & Comfort Care Program
With private offices at:
9107 Wilshire Blvd, suite 475
Beverly Hills, CA 90210
To find a National Register credentialed psychologist who lists biofeedback as an area of expertise, use the search function in the upper right hand corner of FindaPsychologist.org and enter your zip code or city and state. From the list of psychologists in your area, you can "Filter by name, areas of expertise, languages spoken, and other options" and select "Biofeedback."