What is biofeedback therapy and who can benefit? Biofeedback therapy is a non-drug treatment in which patients learn to control bodily processes that are normally involuntary, such as muscle tension, blood pressure, or heart rate........

1. What is biofeedback therapy and who can benefit?
Biofeedback therapy is a non-drug treatment in which patients learn to control bodily processes
that are normally involuntary, such as muscle tension, blood pressure, or heart rate.
It may help in a range of conditions, such as chronic pain, urinary incontinence, high blood
pressure, tension headache, and migraine headache.
As it is noninvasive and does not involve drugs, there is a low risk of undesirable side effects.
This could make it suitable for those who wish to avoid medications, or those who cannot use
them, such as during pregnancy.
It is often combined with relaxation training.
How it works
Biofeedback therapy
Biofeedback therapy can help people change unhealthful habits by interpreting factors such as
electrical brain activity.
There are three common types of biofeedback therapy:
1. Thermal biofeedback measures skin temperature.
2. Electromyography measures muscle tension.
3. Neurofeedback, or EEG biofeedback focuses on electrical brain activity.
EEG biofeedback may help patients with attention deficit hyperactivity disorder (ADHD),
addiction, anxiety, seizures, depression, and other types of brain condition.
During a biofeedback session, the therapist attaches electrodes to the patient's skin, and these
send information to a monitoring box.
The therapist views the measurements on the monitor, and, through trial and error, identifies a
range of mental activities and relaxation techniques that can help regulate the patient's bodily
processes.
Eventually, patients learn how to control these processes without the need for monitoring.
How many sessions will I need?
Sessions typically last less than one hour.
For some conditions, patients experience relief in eight to 10 sessions. For other conditions,
such as high blood pressure, improvements may take 20 sessions to appear.
Alongside these sessions will be mental and relaxation activities that the individual will complete
at home for 5 to 10 minutes a day.

2. Uses
It remains unclear why or how biofeedback works, but it appears to benefit people with
conditions related to stress, according to The University of Maryland Medical Center (UMM).
When a person experiences stress, their internal processes — such as blood pressure — can
become irregular. Biofeedback therapy teaches relaxation and mental exercises that can
alleviate symptoms.
Migraine
People often seek biofeedback and relaxation techniques to treat headaches and migraine, but
studies into its effectiveness have produced mixed results.
In 2015, a Japanese study found that biofeedback therapy reduced the frequency and severity
of symptoms in people with migraine headaches.
However, in 2009, other researchers reported that while relaxation appears to benefit people
with migraine headaches, combining relaxation with biofeedback does not seem to produce
additional benefits.
"Biofeedback is an extremelycostly and time-consuming treatment modality that, in our
study, provided no additional benefit when compared to simple relaxation techniques
alone, in the treatment of migraine and tension-type headaches in adults."
The Michigan Headache and Neurological Institute (MHNI) suggest that biofeedback therapy
improves symptoms of headache and migraine in 40 to 60 percent of patients, similar to the
success rate of medications.
They propose that combining biofeedback with medication may increase the effectiveness of
both. However, while biofeedback may help relieve stress-induced migraine, migraines due to
other triggers may be less responsive.
What Is Hypnosis?
Hypnosis is a procedure involving cognitive processes (such as imagination) in which a patient
is guided by a health professional to respond to suggestions for changes in perceptions,
sensations, thoughts, feelings, and behaviors.21 According to the Society of Psychological
Hypnosis (Division 30), hypnosis involves learning how to use your mind and thoughts to
manage emotional distress (such as anxiety); unpleasant physical symptoms (such as pain);
and certain habits or behaviors (such as smoking). Sometimes, people also are trained in self-
hypnosis, through which they learn to guide themselves during a hypnotic procedure.
How can hypnosis help my patients cope with chronic pain?
Hypnosis has been found to be generally more effective than other non-pharmacologic
interventions, such as physical therapy and pain education.24-27 There is growing evidence to
suggest that hypnosis has greater influence on the affects of pain rather than the sensation of

3. pain.28,29
Hypnosis may be able to provide analgesia, reduce stress, relieve anxiety, improve sleep,
improve mood, and reduce the need for opioids. Further, hypnosis can enhance the efficacy of
other well-established treatments for pain.
Clinical hypnosis should be conducted only by trained health care professionals, such as
licensed psychologists or masters’ level clinicians. There are some contraindications for
hypnosis that one must keep in mind. First, patients should provide informed consent before
beginning the hypnotic process. Health professionals who conduct hypnosis may not be
comfortable providing this type of therapy to all patients. It is important to remember that the
working relationship of the provider and patient is important and can have an effect on treatment
outcomes.
Not everyone is a candidate for hypnosis, and certain cases are discouraged to pursue
hypnosis, including anyone with severe psychological disorders that have gone untreated,
persons under the influence of recreational drugs or alcohol, and anyone who is having
delusions or hallucinations at the time of treatment. Some patients may object to hypnosis due
to their religious beliefs (that these practices are condemned in the Bible), cultural beliefs
(hypnosis is not applicable to personal experience), and/or external factors (provider
characteristics).
Thus, these patients may be drawn more towards the use of biofeedback, with its more scientific
and medical appearance.4 Furthermore, some providers may be able to enhance the efficacy of
hypnosis by including biofeedback.
Relaxation techniques such as guided imagery, progressive muscle relaxation, and breathing
techniques may be useful in managing pain.
Chronic pain is complex. Research over the past 25 years has shown that pain is influenced by
emotional and social factors. These need to be addressed along with the physical causes of
pain. Chronic stress is one factor that contributes to chronic pain. The good news is that you
can get natural pain relief by making relaxation exercises a part of your pain-management plan.
Relaxation Techniques for Natural Pain Relief
Relaxation exercises calm your mind, reduce stress hormones in your blood, relax your
muscles, and elevate your sense of well-being. Using them regularly can lead to long-term
changes in your body to counteract the harmful effects of stress.
Jacobson’s relaxation technique is a type of therapy that focuses on tightening and
relaxing specific muscle groups in sequence. It’s also known as progressive relaxation
therapy. By concentrating on specific areas and tensing and then relaxing them, you can
become more aware of your body and physical sensations.
Dr. Edmund Jacobson invented the technique in the 1920s as a way to help his patients deal
with anxiety. Dr. Jacobson felt that relaxing the muscles could relax the mind as well. The

4. technique involves tightening one muscle group while keeping the rest of the body relaxed, and
then releasing the tension.
Used mainly to treat pain problems such as tension,migraine headache,rheumatoid
arthritis, and lower back pain.
NIHT (National Institutes of Health Technology) panel give highest rating to this
technique in controlling in controlling pain.
Guided Imagery: The premise of guided imagery is to move your focus from the negative to the
positive. Using a script or recording, or with the help of a practitioner, imagine that you are in a
serene location. Engage every one of your senses, incorporating colors, sounds, tastes, scents,
and textures into your experience. Going on this inner journey for 10 minutes twice each day
can help you relax, and can lay the groundwork for a mental place to escape when you are
experiencing pain.
Cognitive behavioral therapy(CBT) is a form of talk therapy that helps people identify and
develop skills to change negative thoughts and behaviors. CBT says that individuals -- not
outside situations and events -- create their own experiences, pain included. And by changing
their negative thoughts and behaviors, people can change their awareness of pain and develop
better coping skills, even if the actual level of pain stays the same.
“The perception of pain is in your brain, so you can affect physical pain by addressing thoughts
and behaviors that fuel it,”
What can CBT do for you?
Cognitive behavioral therapy helps provide pain relief in a few ways. First, it changes the way
people view their pain. “CBT can change the thoughts, emotions, and behaviors related to pain,
improve coping strategies, and put the discomfort in a better context,” Hullett says. You
recognize that the pain interferes less with your quality of life, and therefore you can function
better.
CBT can also change the physical response in the brain that makes pain worse. Pain causes
stress, and stress affects pain control chemicals in the brain, such as norepinephrine and
serotonin, Hullett says. “CBT reduces the arousal that impacts these chemicals,” he says. This,
in effect, may make the body’s natural pain relief response more powerful.
To treat chronic pain, CBT is most often used together with other methods of pain management.
These remedies may include medications, physical therapy, weight loss, massage, or in
extreme cases, surgery. But among these various methods of pain control, CBT is often one of
the most effective.
“In control group studies, CBT is almost always as least as good as or better than other
treatments,” Hullett says. Plus, CBT has far fewer risks and side effects than medications or
surgery.

5. To help provide pain relief, cognitive behavioral therapy:
Encourages a problem-solving attitude. “The worst thing about chronic pain is the sense of
learned helplessness -- ‘there is nothing I can do about this pain,’” Hullett says. If you take
action against the pain (no matter what that action is), you will feel more in control and able to
impact the situation,” he says.
Involves homework. “CBT always includes homework assignments,” Hullett says. “These may
involve keeping track of the thoughts and feelings associated with your pain throughout the day
in a journal, for example. “Assignments are then reviewed in each session and used to plan new
homework for the following week.”
Fosters life skills. CBT is skills training. “It gives patients coping mechanisms they can use in
everything they do,” Hullet says. You can use the tactics you learn for pain control to help with
other problems you may encounter in the future, such as stress, depression, or anxiety.
Allows you to do it yourself. Unfortunately, good qualified cognitive behavioral therapists aren’t
available in all areas. Luckily, you can conduct CBT on your own as a method of pain control,
even if you’ve never set foot in a therapist’s office. “CBT is a cookbook approach. It can easily
be applied to self-help and computerized programs,” Hullett says. And the literature supports
that these self-help methods can be just as effective for pain management as one-on-one
sessions.