Patient, Heal Thyself
Business Week
BY SUSAN GARLAND
10-16-2000
Biofeedback moves toward the mainstream
Stroke survivors who are partly paralyzed have a tough time re-educating
muscles to respond to mental cues. Biofeedback, a technique much derided
by physicians in the past, is proving to be a most effective teaching aid.
A patient's hand, say, is hooked up to a machine that measures muscle tension.
The patient then tries to close her hand. Her mind tells the muscle to
tighten. The hand doesn't move.
But a blip appears on the computer screen: A firing has occurred in
the muscle, just the sort of feedback the patient needs to keep trying.
After a number of sessions the blips get bigger, and eventually the hand
responds. Says Rob Kall, a biofeedback practitioner in Newtown, Pa., whose
Web site, futurehealth.org, promotes the method: ``It gives them information
that's essential to the learning process.''
Such successes are now moving the technique from the fringes of alternative
treatment into mainstream medicine. Biofeedback helps teach patients to
regulate, consciously, such functions as heart rate, blood pressure, body
temperature, and even brain wave patterns. Physiological data on a computer
screen create a positive-reinforcing feedback loop that helps people learn
basic techniques more quickly (table). Eventually, patients can alter their
physiological responses without the machine.
Thanks to a growing body of data that shows the technique to be effective,
people are increasingly turning to biofeedback to help treat about 150
conditions, including epilepsy, incontinence, hypertension, migraine headaches,
chronic pain, and attention deficit disorder (ADD). Some doctors are sending
patients to biofeedback practitioners, and hospitals are adopting the technique
for certain ailments.
Even insurance companies are starting to cover it. A biofeedback session
costs from $50 to more than $100, and a course of treatment can range from
four sessions to more than 50. Bob Whitehouse, a practitioner in Boulder,
Colo., who follows insurance trends for the Biofeedback Certification Institute
of America, says that about half of the major medical companies now cover
biofeedback treatments for some 40 conditions.
Many doctors are still skeptical. They argue that claims of dramatic
results are not backed up by the kind of costly, controlled studies that
pharmaceutical companies conduct on their products. But the National Institutes
of Health has endorsed biofeedback to alleviate tension headaches and insomnia.
A San Francisco State University study found that asthma patients who used
biofeedback to learn new breathing techniques suffered fewer attacks and
used less medicine. A study reported in the Journal of the American Medical
Association noted a large decline in urinary incontinence. And biofeedback
techniques developed by NASA to help astronauts handle space sickness are
being used to treat people with severe and chronic vomiting.
Dr. Naras K. Baht, an internist and cardiologist in Concord, Calif.,
uses biofeedback as part of his treatment of heart disease. He says area
cardiologists send patients to his program, which also includes meditation
and seminars on stress reduction. ``Anger and stress are major players
in producing heart attacks,'' he says. ``Biofeedback helps people unlearn
their anger patterns.''
The fastest growing area of biofeedback uses an electroencephalogram
(EEG) to measure brain wave activity. Sometimes called neurofeedback, it's
used to treat depression, epilepsy, and migraines. The technique also shows
great promise for people with ADD.
Pioneering work by Joel Lubar, a psychology professor at the University
of Tennessee, shows that many kids suffering from ADD exhibit low-frequency
brain waves. As their brain waves rise in frequency, they're able to concentrate
better. Biofeedback practitioners have rigged up software that shows brain
wave activity as a simple computer game, such as a maze, instead of as
a boring line graph. Higher-frequency waves make a figure move through
the maze. So when the child concentrates, the figure moves. When the child
stops concentrating, the frequency falls and the figure stops moving.
Adults as well as kids who've undergone EEG therapy have improved attention
spans, do better at school and work, and are less dependent on such medications
as Ritalin. A 10-year followup shows that these improvements last, Lubar
says.
More radical is a way of sending radio waves back through the EEG to
force a patient's brain waves into new patterns. Mary Lee Esty, a Washington
biofeedback practitioner, is using this technique to help fibromyalgia
patients, who suffer from chronic fatigue and muscle pain. Her Neurotherapy
Center of Washington is sharing a $1 million grant, with Chicago's Rush-Presbyterian-St.
Luke's Medical Center, to study whether fibromyalgia, long considered an
immune disorder, is actually a neurological condition treatable by changing
brain wave patterns.
Esty used her technique to treat Linda McBee, who sustained a brain
injury in a 1992 car accident. Because she suffered from chronic pain and
an inability to concentrate, McBee had to give up her job in Baltimore.
She lived on morphine, muscle relaxants, and anti-seizure medication. But
after a year of Esty's treatments, McBee, 37, is no longer on medication,
has a job with a financial adviser--and is studying for her stockbroker
exam. ``I went swing dancing the other night and then went to work the
next day,'' she says proudly.
If you're considering biofeedback, check with your doctor first: Insurers
typically require a referral from a physician or a psychologist before
they'll cover a treatment. And you'll want a diagnosis, to rule out conditions
that can only be treated medically.
Check out practitioners with the Biofeedback Certification Institute
of America (table), which makes providers meet rigorous requirements. ``It's
an unregulated field,'' says Judy Crawford, the institute's director of
certification. ``Anyone can take a weekend course in biofeedback and hang
up a shingle.'' And when questioning a practitioner about success rates,
ask for objective studies on the therapy's effectiveness.
With mounting evidence that biofeedback can help alleviate many disorders,
it may be just a question of time before physicians accept it as standard
practice. Meanwhile, patients with nagging symptoms that won't go away
may discover that mind can indeed prevail over matter.
ASSOCIATION OF APPLIED PSYCHOTHERAPY AND BIOFEEDBACK
www.aapb.org
303 422-8436
BIOFEEDBACK CERTIFICATION INSTITUTE OF AMERICA
www.bcia.org
303 420-2902
FUTUREHEALTH
www.futurehealth.org
215 504-1700
THE BIOFEEDBACK NETWORK
www.biofeedback.net
610 933-8145
How It Works
Biofeedback helps teach patients to regulate, consciously, such bodily
functions as heart rate, blood pressure, temperature, and even brain wave
patterns. Here's what happens:
- A therapist attaches sensors to the patient's body to monitor physiological responses--an electrode on the chest, for instance, measures heart rate
- The readings are displayed, usually on a computer screen, for the patient
to see
- The therapist teaches the patient techniques--such as deep breathing, simple exercises, or visualization--to help alter the readings
- The readings on the screen give the patient feedback about how well the techniques are succeeding
- Patients must spend hours practicing the techniques on their own
- Eventually, they're able to alter their physiological responses without the machine
http://www.ect.org/selfhelp/biofeedback.html