Managing Stress with Biofeedback
by Arne Anderson, BA, BCIAC
Stress is a topic which seems to surface in more and more conversations. "He stressed me out . . . I was so stressed I forgot her name . . . The stress around here is too much . . . I thrive on stress" are just some common expressions. It can be considered a topic which is woven deeply into the social and economic fabric of this country. Fortunately, in recent years, we have improved our understanding of how the brain and body work in response to stress.
Stress is first and foremost a necessary part of our lives. Without it, boredom sets in; too much of it can be overwhelming and exhausting. Hans Selye, M.D., a pioneer in stress research, defines stress as "the non-specific response of the body to any demand made on it (when external demands exceed resources)."1 He identified three primary stages to adapting to stress. The first is called the alarm reaction to the stressor which ultimately activates the autonomic nervous system. Secondly, the resistance stage occurs as the body acclimates itself and adjusts to the stressor. Finally, comes the exhaustion stage if stress occurs for too long and the residual effects of stress add up. Ultimately, illness and death can occur.
Years ago, many health professionals and researchers felt that the mind and
body behaved completely independently of one another. Today, it is clear that the mind and body are interrelated. Stress, therefore can be considered a complex physical and emotional reaction. This reaction is largely based on perception. In other words, if one perceives a situation as stressful then
they will respond accordingly. What is stressful to one person may not be to another. Our body will prepare us for stress through both conscious and unconscious pathways, whether we are aware of it or not. A thought is first registered in the brain which ultimately leads to activation of the nervous system in the body. A complex series of events occur in a an extremely small amount of time. Thinking stressful or fearful thoughts during this time further increases the body's attempt to prepare to fight or flee. This will occur whether or not such preparation is necessary.
In a fast paced and stressed-filled world, many people are primarily unaware
of stress signals in their body until it demands attention. For example, one can receive information from the body that they are emotionally fearful. Butterflies in the stomach, sweating, shakiness, etc. These signals can also be denied on a cognitive level, "I am not nervous . . . there is no reason to be." However, the body is a more reliable indicator of nervous tension and stress. Therefore, it is important to tune into the body's signals. This is a skill which can be improved with biofeedback training. A biofeedback therapist can help coach the learning of new self-regulation skills.
Stress may tend to build up as the day progresses. This can be referred to as
the staircase effect. If we do not have time to adapt to the stress then we go into the next stress situation with some residual stress. This is similar to taking another step up on a staircase. If we climb too high, the pressure builds. Short-term relaxation techniques at different times during the day can prevent the stress from building to an unmanageable level. Cognitive coping strategies and biofeedback training helps improve these skills. As awareness increases, there is greater ability to discern between tension and relaxation and there are more options to do something about it.
Biofeedback continues to emerge as a viable and scientifically based treatment
for an increasing number of conditions. Biofeedback is a therapeutic tool which provides physiological information in order to help individuals improve self-regulation skills. The principles of biofeedback are used every time you step on a scale or use a thermometer. Similarly, sensitive biofeedback
instruments are used to measure your body's physiological processes such as temperature, skeletal muscle tension, and heart rate, which are often not generally within one's awareness. Biofeedback treatment sessions are usually held one to one with the patient and therapist. Therapy takes place in a comfortable chair in a room free of distractions. Each aspect of treatment is thoroughly explained to the patient.
For thermal biofeedback, a thermistor is gently attached to the hand, foot or other clinically indicated site with a small piece of tape in order to measure peripheral skin temperature. During stress, blood vessels become constricted and pass less warm blood. Thermal biofeedback training helps individuals combat the stress response which is measurable as an increase in skin temperature.
For electromyograph biofeedback, the skin is first prepped by lightly cleaning the surface of the skin to allow for proper contact. Three self-adhesive sensors about the size of a dime are attached to the forehead, arm or other clinically indicated site. From the instrument, a cable with three electrodes attach to the sensors with a small clip. Electromyograph biofeedback measures the electrical activation of the muscle that signals it to contract. Electromyographic biofeedback training helps individuals learn to relax overly contracted muscle groups which may help to reduce tension. As training progresses, individuals learn to use the information from the instruments to assist them in discriminating between tension and relaxation.
Sophisticated biofeedback instruments transfer the physiological information
from the body, amplify it, and convert it into a readable signal. The instruments can be programmed so that as one relaxes, tones or beeps (auditory) or a light bar display (visual) confirm that a certain level of relaxation has been achieved. A training threshold level is set at a progressively more challenging level during the course of treatment. As awareness increases and new self-regulation skills are learned, many clients feel more confident that they can, to a larger extent control aspects of their functioning that were once thought to be completely uncontrollable. This
demands regular practice between sessions in order to integrate new skills.
Typically, the instruments are used in the beginning of the session to allow
for a baseline reading, giving the therapist and patient a starting point. The next part of the of the session may be spent reviewing recent stressors of the past week, educating the patient about their symptoms, teaching coping strategies, and reviewing how to integrate relaxation strategies into their life. Most of the session is then spent on practicing a relaxation exercise. This may include progressive muscle relaxation, breathing exercises, visualization, imagery, autogenic training, or other related techniques such as meditation. These may be narrated from the therapist or may be included on a cassette tape. Patient's can be given cassette tapes to practice between sessions. Many therapist's also give patients educational materials which helps to make the treatment more comprehensive.
The following case studies help to illustrate how biofeedback is used:
HELEN'S TENSION HEADACHES - ELECTROMYOGRAPH BIOFEEDBACK
Helen, a 43 year old, female patient began biofeedback treatment with complaints of tension headaches. "I get them all the time . . . they seem to come from nowhere". Electromyograph biofeedback training was used to help her discriminate between muscular tension and relaxation. Helen learned deep breathing and other relaxation exercises which she began to practice to see which ones worked for her. In addition, she began to keep track of her headaches and improved her ability to anticipate what usually sets them off. Factors she identified included exercises, work demands, selected food items, conflictual interpersonal relationships, and limited time for herself. Helen gradually made changes in how she handled these situations. Through continued practice and eight sessions of Biofeedback, this patient improved her ability to reduce the frequency and intensity of her tension headaches. A follow up session in one month showed sustained improvement.
JOHN'S STRUGGLE WITH ANXIETY - THERMAL BIOFEEDBACK
John, a 33 year old, male professional had experienced anxiety for most of his life. Recently, his psychotherapist recommended biofeedback to help him learn anxiety management techniques. During the beginning phase of his treatment, he learned that there are usually several signals to alert him that his nervous system is overactive. John's feet and hands get cold along with
other physiological signals. Thermal biofeedback training helped him confirm when he was relaxing by measuring an increased blood flow to his extremities and alerting him with visual and auditory signals. John also found that practicing relaxation techniques between sessions at home and at work, helped him in managing his anxiety. His confidence improved as he practiced transferring the relaxation skills to his everyday life. After ten sessions, he was able to continue building his skills without the equipment. In a follow up after one month, John enthusiastically stated, "I still sometimes get anxious, but feel I have many tools to deal with it."
Well designed research continues to be conducted which supports biofeedback to treat symptoms which are intensified by stress. The Association for Applied Psychophysiology and Biofeedback (AAPB) has established efficacy for clinical biofeedback. The following diagnosis have met efficacy criteria for treatment by biofeedback therapy:
- Anxiety Disorders
- Asthma
- Attention Deficit and Hyperactivity
- Dysmenorrhea
- Epilepsy
- Essential Hypertension
- Headache
- Incontinence
- Insomnia
- Irritable Bowel
- Motion Sickness
- Myofacial Pain
- Temporomandibular Joint (TMJ) Pain
- Mandibular Dysfunction
- Neuromuscular Disorders
- Pain
- Chronic
- Rheumatoid Arthritis
- Raynaud's Disease
For more information, contact AAPB at (800) 477-8892.
A free, client information booklet is available by calling this number.
Biofeedback therapists are represented by several health care fields including:
- Medical doctors
- Psychologists
- Social workers
- Physical therapists
- Occupational therapists
- Nurses
- Other related fields
Be cautious starting treatment with a professional who states that they can treat "anything." Because the training necessary to provide competent biofeedback services is extensive, most professionals treat disorders in which they specialize. The Biofeedback Certification Institute of America (BCIA) certifies biofeedback therapists through a written and oral national examination.
This certification indicates the professional demonstrated a fundamental competence to use biofeedback instrumentation for the purposes of monitoring, recognizing and assisting in physiological self-regulation according to the ethical principles and practices of the BCIA. For more information, contact the BCIA at (303) 420-2902.
References:
- Selye, H., (1956). The Stress of Life. New York, Toronto, London: McGraw-Hill Book Co., Inc.
- Schwartz, M.S. & Associates, (1995). Biofeedback: A Practitioner's Guide. New York, London: The Guilford Press.
About the Author:
Arne Anderson, BA, BCIAC has over eight years of experience in the mental health field as a group leader and educator. He has seen clients for biofeedback treatment the past two years and is currently in private practice. Arne treats client's in Chicago and its suburbs.
Currently, Arne serves on the Board of Directors of the Biofeedback Society of Illinois and is a member of the Association for Applied Psychophysiology and Biofeedback. As a certified biofeedback therapist by the Biofeedback Certification Institute of America (BCIA), Arne specializes in treating tension headaches, migraines, hypertension, anxiety and panic, and helping clients improve stress management skills. He believes that individuals have the capacity for changing the way they think, feel and behave, which can transcend beyond symptom relief. He provides both support and education to clients as
they learn to master new skills.
Page last modified or reviewed on January 13, 2010
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