Biofeedback Training Techniques

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Biofeedback teaches individuals to control functions of their autonomic (involuntary) nervous system. These functions include heart rate, blood pressure, skin temperature, muscle tension, and brainwave activity.

Individuals learn to control these functions by observing monitoring devices and reproducing desired behavior. Relaxation techniques are also used to control these bodily functions. Relaxation techniques include progressive relaxation exercises, yoga, Transcendental Meditation, or simply focusing on an image of quiet, rest, and solitude.

In successfully treating patients with biofeedback, the appropriate method must be selected. Patients with migraine may be helped with skin temperature feedback, but the combination of electromyographic (EMG) and temperature feedback training is preferred for most headache patients.

It is essential the patient is self-directing the therapy because the healthcare provider only serves as a teacher. Below are some examples of biofeedback training:

Temperature Training Phases

The patient receiving temperature feedback training first uses a temperature monitor at home for four weeks. A thermistor, a form of temperature reader, is attached to the index finger of the dominant hand. Skin temperature indicates changes in the diameter of the small blood vessels (i.e., arterioles) that supply blood to the skin. The goal is to increase the skin temperature of the hands, thereby increasing the blood flow to that area and away from the head. The patient practices twice daily, using the phrases listed below. These are known as autogenic phrases and were formulated by Dr. Johannes Schultz, during the 1930s

I feel quiet … I am beginning to feel quite relaxed … my feet feel heavy and relaxed … my ankles, my knees, and my hips feel heavy, relaxed, and comfortable … my solar plexus and the whole central portion of my body feel relaxed and quiet … my hands, my arms, and my shoulders feel heavy, relaxed, and comfortable … my neck, my jaw, and my forehead feel relaxed … my whole body feels quiet, heavy, comfortable, and relaxed.

I am quite relaxed … my arms and hands are heavy and warm … I feel quite quiet … my whole body is relaxed, and my hands are warm, relaxed and warm … my hands are warm … warmth is flowing into my hands, they are warm … warm.

Progressive Relaxation Exercises

In EMG biofeedback, electrodes (similar to those used in EKGs), are placed on the patient’s forehead or neck to measure muscle tension in those areas. As tension increases, the EMG monitor will increase its noise. The noise will decrease as the tension decreases. Patients may receive this training twice weekly for four weeks. Without the monitor, the patient can continue to practice the progressive relaxation exercises daily and whenever they experience a headache.

Let all your muscles go loose and heavy. Just settle back quietly and comfortably … Wrinkle up your forehead now; wrinkle and smooth it out. Picture the entire forehead and scalp becoming smoother as the relaxation increases … Now frown and crease your brows and study the tension … Let go of the tension again, smooth out the forehead once more … Now, close your eyes tighter and tighter. Feel the tension … Now relax your eyes. Keep your eyes closed, gently, comfortably, and notice the relaxation … Now clench your jaws. Bite your teeth together; study the tension throughout the jaws … Relax your jaws now. Let your lips part slightly … Appreciate the relaxation.

Now press your tongue hard against the roof of your mouth. Look for the tension … All right, let your tongue return to a comfortable and relaxed position … Now purse your lips, press your lips together tighter and tighter … Relax the lips. Note the contrast between tension and relaxation. Feel the relaxation all over your face, all over your forehead and scalp, eyes, jaws, lips, tongue, and your neck muscles … Press your head back as far as it can go and feel the tension in the neck. Roll it to the right and feel the tension shift … Now roll it to the left … Straighten your head and bring it forward and press your chin against your chest. Let your head return to a comfortable position, and study the relaxation. Let the relaxation develop.

Shrug your shoulders right up. Hold the tension … drop your shoulders and feel the relaxation. Neck and shoulders are relaxed … Shrug your shoulders again and move them around. Bring your shoulders up and forward and back. Feel the tension in your shoulders and in your upper back. Drop your shoulders once more and relax. Let the relaxation spread deep into the shoulders, right into your back muscles. Relax your neck and throat, and your jaws and other facial areas as the pure relaxation takes over and grows deeper … deeper … ever deeper.