Patient, Heal Thyself
BY SUSAN GARLAND
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
BIOFEEDBACK CERTIFICATION INSTITUTE OF AMERICA
THE BIOFEEDBACK NETWORK
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: