Biofeedback treatment of gastrointestinal disorders

Biofeedback has had a greater impact on gastroenterology than on any other medical subspeciality. Biofeedback is the treatment of choice for many of the most common types of fecal incontinence, and preliminary studies suggest that it is likely to become a preferred method for treating patients with constipation related to inability to relax the striated pelvic floor muscles during defecation. This dysfunction may account for up to 50% of patients with chronic constipation. Thermal biofeedback forms part of a multicomponent behavioral treatment for irritable bowel syndrome that is reported to be effective, and other promising applications of biofeedback for gastrointestinal disorders are under investigation.Supported by NIMH Research Scientist Award No. KO5 MH00133.     

Biofeedback treatment of atopic dermatitis

To investigate the feasibility of a behaviorally oriented intervention program with atopic dermatitis, 12 patients were exposed to a fixed sequence of treatment phases including a no-treatment baseline phase, a phase incorporating nonspecific treatment factors, and a phase involving frontal electromyographic (EMG) feedback and relaxation instructions. Photographic analyses of involved skin areas revealed significant remission of dermatological problems across the entire program, although significant changes could not be attributable to any specific phase. Ratings of itching level decreased within but not across treatment sessions, and variable correlations across subjects were found between frontal EMG and itching level. MMPI results from the dermatitis subjects were within normal limits. Overall, the results provided mixed support for the hypothesis that atopic dermatitis may be amenable to intervention through behaviorally oriented treatment procedures.     

Biofeedback treatment of gastrointestinal disorders.

Biofeedback has had a greater impact on gastroenterology than on any other medical subspecialty. Biofeedback is the treatment of choice for many of the most common types of fecal incontinence, and preliminary studies suggest that it is likely to become a preferred method for treating patients with constipation related to inability to relax the striated pelvic floor muscles during defecation. This dysfunction may account for up to 50% of patients with chronic constipation. Thermal biofeedback forms part of a multicomponent behavioral treatment for irritable bowel syndrome that is reported to be effective, and other promising applications of biofeedback for gastrointestinal disorders are under investigation.     

Biofeedback treatment of Raynaud's disease and phenomenon

Six Raynaud's disease and four Raynaud's phenomenon patients were treated with 12 sessions of finger temperature biofeedback. The mean frequency of vasospastic attacks was reduced to 7.5% of that reported during the pretreatment baseline and was maintained for a 1 year follow-up period. Significant control of digital temperature was demonstrated during laboratory training sessions. Raynaud's phenomenon patients showed significantly greater temperature increases during feedback periods than Raynaud's disease patients. Correlations between finger temperature and other physiological measures suggested that results could not be attributed to general physical relaxation. The role of imagery in self-control of digital temperature is considered.Portions of this paper were presented at the annual meeting of the Biofeedback Society of America, Albuquerque, March 1978.     

Biofeedback and progressive relaxation treatment of sleep-onset insomnia

Previous research suggests that self-defined insomniacs are distinguished from normals by high levels of anxiety and physiological arousal, which might be mitigated by muscle relaxation. This study assessed the relative effects of frontal EMG biofeedback, progressive relaxation, and a placebo set of relaxation exercises on the sleep of 18 onset insomniacs. Each subject was trained in one of these three methods for six half-hour sessions and slept in the laboratory for two consecutive nights before and after training. The experimental groups demonstrated significant decreases in physiological activity during training while changes in the control group were minimal. Reductions in sleep-onset time were: biofeedback group, 29.66 minutes; progressive relaxation group, 22.92 minutes; control group, 2.79 minutes. The experimental groups improved significantly(p<.05) more than the control group, but did not differ from each other. No significant relationships between physiological levels and sleep-onset time were found, which suggests that muscle relaxation alone was not responsible for subjects' improvements. Since 20 minutes of daily practice were required to achieve an approximate 30-minute decrease in sleep-onset time, the practical utility of the methods is questioned.Portions of this paper were presented at the 15th Annual Meeting of the Association for the Psychophysiological Study of Sleep, Edinburgh, July, 1975, and at the 6th Annual Meeting, Biofeedback Research Society, Monterey, California, February, 1975.     

Biofeedback in treatment of urinary incontinence in stroke patients

Urinary incontinence can occur poststroke owing to weakness or incoordination of sphincter muscles, impaired bladder sensation, or hyperreflexic, neurogenic bladder. Four male subjects who had urinary incontinence associated with a stroke that had occurred 8 months to 10 years earlier, and who averaged 1.6 to 7.5 accidental voidings per week, participated in an outpatient study with a 4-week scheduled-voiding baseline, 2 to 5 sessions of biofeedback-assisted bladder retraining, and 6- to 12-month follow-up. Training sessions included stepwise filling of the bladder and manometric feedback display of bladder pressure, abdominal pressure, and external anal sphincter pressure. Training procedures were designed to teach subjects to attend to bladder sensations, inhibit bladder contractions, and improve voluntary sphincter muscle control. All four subjects achieved and maintained continence regardless of substantial differences in subject characteristics, including laterality of stroke, degree of sensory impairment, and independence in daily activities.     

Biofeedback in treatment of urinary incontinence in stroke patients

Urinary incontinence can occur poststroke owing to weakness or incoordination of sphincter muscles, impaired bladder sensation, or hyperreflexic, neurogenic bladder. Four male subjects who had urinary incontinence associated with a stroke that had occurred 8 months to 10 years earlier, and who averaged 1.6 to 7.5 accidental voidings per week, participated in an outpatient study with a 4-week scheduled-voiding baseline, 2 to 5 sessions of biofeedback-assisted bladder retraining, and 6- to 12-month follow-up. Training sessions included stepwise filling of the bladder and manometric feedback display of bladder pressure, abdominal pressure, and external anal sphincter pressure. Training procedures were designed to teach subjects to attend to bladder sensations, inhibit bladder contractions, and improve voluntary sphincter muscle control. All four subjects achieved and maintained continence regardless of substantial differences in subject characteristics, including laterality of stroke, degree of sensory impairment, and independence in daily activities.     

Biofeedback and the behavioral treatment of disorders of disregulation.

This paper reviews biofeedback research from the perspective of cybernetic/feedback theory and applies the theory to the behavioral treatment of psychosomatic disorders. The concept of disregulation is used to elucidate how environmental factors can modulate the central nervous system and effect homeostatic, self-regulatory control of peripheral organs. When feedback from peripheral organs is disrupted, it is hypothesized that disregulation occurs, leading to physiological instability and functional disease. Within this framework, biofeedback provides a new feedback loop that can help individuals regain physiological self-control. Basic research using biofeedback to enhance self-regulation of cardiovascular responses is reviewed. The use of biofeedback in the behavioral treatment of disorders such as tension and migraine headache, hypertension, and epilepsy are selectively reviewed and critically evaluated. The need to consider feedback mechanisms in behavioral and biomedical approaches to treatment is highlighted. Predictions regarding the potential inadvertent perpetuation of disregulation and disease through inappropriate biomedical intervention is also considered.     

Biofeedback in the treatment of headache and other childhood pain

Since the first biofeedback (BFB) studies on pediatric pain were published in the early 1980s, most of the studies have focused on the treatment of pediatric migraine. More recently, BFB has also been evaluated in the treatment of tension headache in children. Not surprisingly, most of what we know about the efficacy and mechanisms of BFB in the treatment of children's pain problems concerns the treatment of childhood headache (HA). In this review, we provide a detailed summary of studies that have evaluated BFB in the treatment of childhood HAs with an emphasis on treatment outcome and maintenance of treatment success. Moreover, findings and hypotheses with regard to the mechanisms that may mediate the treatment effects of BFB are addressed. Finally, we discuss specific issues relating to the treatment of pain in children with BFB and outline future directions of research.     

Biofeedback techniques in the treatment of visual and ophthalmologic disorders

The literature on the use of biofeedback techniques in the treatment of visual and opthalmologic disorders is reviewed. Although this consists mainly of case studies, there is mounting evidence that biofeedback may be applicable to the treatment of strabismus, nystagmus, blepharospasm, elevated intraocular pressure, and myopia. Because of the success in applying biofeedback techniques in the treatment of other neuromuscular disorders, it is concluded that the use of these techniques in the treatment of blepharospasm and strabismus shows the most promise.     

Biofeedback as an adjunct to psychotherapy in the treatment of vaginismus

This exploratory study examines the use of biofeedback as an adjunct to psychotherapy in the treatment of vaginismus. A set of six Sims-type graded EMG probes was constructed to provide biofeedback from the vaginal sphincter and was tested on a pilot sample of nulliparous women prior to this study. Five sequential cases of vaginismus from a clinic waiting list participated in the program. All five couples completed the program and all reported successful intercourse at its conclusion. The number of sessions devoted to biofeedback probe insertion was almost halved in comparison to previous experience with Sims dilators. Overall treatment duration was not shortened. At follow-up 6 months later, two couples reported pregnancy, one couple was having regular intercourse, and two couples had ceased intercourse. The authors conclude that biofeedback is an effective aid to learning muscle control, is acceptable to patients, and may increase the success rate by minimizing dropouts. The importance of follow-up is stressed.We wish to thank Mr. John Conboy, senior technician, Department of Psychiatry, University College, Dublin, for his help in setting up and running this experiment.