The Benefits of Biofeedback

It's gaining ground as a stress-management tool

Because she was planning to get pregnant, Janelle (who preferred not to give her last

name) decided last year to go off powerful medication for stress-induced migraines in

favor of a more fetus-friendly therapy.

With sensors attached to her fingertips, neck, and abdomen, she spent 20 sessions

learning to relax her muscles and slow her breathing and heart rate while watching a

computer monitor for proof of the desired result. Eventually, she was able to do the

work on her own. "The migraine pain doesn't go away completely," says the 39-year

old from Bethesda, Md., who has remained off medication since her son's birth two

months ago. "But it's been greatly reduced, and I'm able to deal with it better."

Like meditation and yoga, the biofeedback method that Janelle now swears by is

enjoying a sort of renaissance; while it's been around for some 40 years, a growing

body of research has brought it to the mainstream, indicating that it can relieve some

hard-to-manage conditions exacerbated by stress. Many major hospitals and clinics,

including Harvard's Brigham and Women's Hospital and Duke University Medical Center,

now offer biofeedback to people with hypertension and jaw pain as well as headaches,

for example. And new pocket-size gadgets have hit the market that let you do it yourself.

Biofeedback's major appeal is that one series of sessions purportedly teaches a set of

skills you can use for life—without side effects. And it's pre-emptive. "Biofeedback teaches

you to identify early signs that stress is starting to get to you and to bring that stress

reaction down before it causes physical symptoms," explains Frank Andrasik, a professor

of psychology at the University of West Florida in Pensacola who serves as editor-in-chief

of the journal Applied Psychophysiology and Biofeedback.

Instructions on a computer screen tell you when to inhale and exhale, for example, so

that you practice slowing down, ideally to about six breaths per minute. The point is to

calm your body's autonomic nervous system, which raises your blood pressure and heart

rate when you're stressed. One important effect: an increase in your "heart rate variability,"

those subtle moment-to-moment fluctuations in the pace of your heartbeat.

Research suggests that lower variability is associated with a higher risk of dying from heart

disease. Tall, even waves cross the computer screen as your breathing slows and the stress

response calms; the waves are short and spiky when you're on edge. Sensors also detect an

increase in your hand's skin temperature, a sign you've lowered the level of "fight or flight"

stress hormones that shunt blood away from your extremities and have entered a state

practitioners call "focused calm." The key is to practice so that you get there automatically

when the traffic jams or the boss screams.

In part, biofeedback's resurgence stems from technological advances that provide instant,

easy-to-understand information, says social worker Mary Lee Esty, head of the Neurotherapy

Center in Bethesda, where Janelle was treated. One computer software program displays an

open-mouthed smiling dolphin when all systems are calm and then jumbles the photo if

breathing becomes uneven or rapid. "The timing of the feedback is absolutely critical to

learning what feels right," Esty explains.

Still seeking proof.

Whether biofeedback actually teaches permanent skills remains unproven. But some long-term

studies suggest that patients are still employing the techniques successfully years later. And

though there's evidence that the therapy works better than sham treatments to lower stress-

related aches and pains, it hasn't been tested against standard treatments like aspirin for tension

headaches—though for many people, like Janelle, getting off medication is the goal. A study

published last year in the Journal of Alternative and Complementary Medicine found that people

with mild hypertension who had four weekly sessions of biofeedback experienced a significantly

greater lowering of their blood pressure than those who had stress reduction training without

the feedback.

Evidence is stronger, Andrasik says, that biofeedback helps with non-stress-related conditions

like chronic constipation and urinary incontinencee, where it's used to retrain the muscles

involved in waste elimination. A newer technique called neurofeedback, which uses scalp

sensors to measure brain waves, appears promising for helping restore normal brain wave

function disrupted by head injuries, post-traumatic stress disorder, and severe migraines.

The biggest caveat for many people will be lack of insurance coverage. While Aetna and

Kaiser Permanente cover biofeedback for certain stress-related conditions, many companies

don't. The Neurotherapy Center's five-session treatment plan for stress costs about $500;

Janelle's 20 sessions—typical for migraine patients—cost her $2,000 out of pocket.

If you proceed, be sure your practitioner is certified by the Biofeedback Certification Institute

of America, since anyone can hang out a shingle; typically, certified practitioners are also

licensed psychologists. Realize, too, that long-term success often rests, literally, in the hands

of the patient. Psychologist Deborah Stokes, who practices biofeedback in Alexandria, Va., t

ells her patients to practice warming their hands—using a $20 home device from Bio-Medical

Instruments—for 20 minutes a night between sessions. Janelle says she still occasionally

practices the techniques she learned and called on them during childbirth. "It really helped

me focus," she says. "I was able to give birth without an epidural."

By Deborah Kotz, US News & World Report