What are biofeedback and relaxation?

Introduction

From the day that people are born, and even before, they are subjected to a variety of stressors from the environment around them. Each one of these exacts a certain toll on their bodies. Some stressors seem to affect individuals differently, while others seem to have a universal effect; in any case, both the mind and the body must mobilize to deal effectively with these factors. The individual is usually able to handle these problems by using various coping strategies to help alleviate the stress. The problem arises when too many stressors are present at one time or when these stressors last too long. Individuals must adapt or change their coping strategies to return to a normal equilibrium. A coping strategy is a process that takes effort and is learned; the individual must acquire this coping skill as one acquires any skill. It must be practiced.

If the stressors are not dealt with adequately, fatigue and illness may result. In the most serious circumstances, the organism can die. Hans Selye reported on what he termed the "general adaptation syndrome (GAS)." As stressors affect an organism, a series of neurological and biological responses occur to protect the body. If these responses are prolonged and go unchecked, however, the body will begin to break itself down. In the first phase, the alarm phase, the body mobilizes itself. The adrenal glands enlarge and release epinephrine (adrenaline) and steroids to cope. After a while, the body adapts and seems to be normal; this is the resistance stage. In fact, the body is not normal. It is very vulnerable to further stress, and, if subjected to additional stressors, it will enter the third stage, exhaustion. The organism can then become extremely sick or die.

Development of Coping Strategies

It becomes essential for the individual to adopt a successful coping strategy to avert this progression of events. Two such techniques will be discussed here. Biofeedback is a procedure whereby the individual is given information about how a variety of body responses react in various circumstances. The individual is generally unaware of these reactions, but biofeedback technology allows the individual to monitor them and eventually bring them under control. Autonomic, visceral responses to stress have traditionally been thought to be involuntary and automatic. Biofeedback is a technique aimed at gaining control over these reactions. Voluntary responses can affect these visceral responses, and this fact complicates the ultimate effectiveness of biofeedback.

Neal E. Miller was one of the early pioneers in the field. His work has been applied to the control of a wide variety of stress-related problems through the use of biofeedback. The control of what have been termed “psychosomatic problems” has been accomplished using Miller’s assumptions. Individuals have learned to control blood pressure, heart rate, muscle spasms, headaches, and myriad other ailments through biofeedback techniques.

Miller believed that these responses to stress can be changed through the use of operant, or instrumental, conditioning and reinforcement. "Operant conditioning" refers to learning that occurs from reinforcing a response and is traditionally thought to be successful with voluntary responses mediated by the skeletal nervous system. When a machine makes this information available to a person, the responses can be reinforced (or they can reinforce themselves) when a therapeutic change occurs. The same principle is at work when an experimental rat learns to press a bar for food.

Another coping strategy that can be used to deal with stressors is the adoption of one of a variety of relaxation procedures. As odd as it may sound to some, people must learn to relax in many situations, and this takes practice. Relaxation techniques are often used in conjunction with biofeedback, which sometimes makes it difficult to determine which of the two procedures is responsible for the changes that occur and to what degree they are acting in relationship to each other.

There are several relaxation techniques, and different techniques are successful for different individuals. One of the most widely used techniques is progressive muscle relaxation, proposed by Edmund Jacobson. The individual is instructed to tense a particular muscle group and hold it for several seconds, paying attention to the feelings associated with this state. Then the individual is told to relax the muscle group and is asked to concentrate on the different feelings while the muscle is relaxed. The major muscle groups of the body are put through this procedure. Ultimately, the individual is able to reproduce the relaxed sensations when feeling tense.

Rhythmic breathing techniques are also used for relaxation to combat stress. The person learns to inhale through the nose to a specified count and exhale through the mouth to another specified count. The breathing should be with the diaphragm as much as possible, as opposed to the chest. Meditation, another relaxation technique that often incorporates rhythmic breathing, may require that the person either visualize an object or repeat a word or phrase with each breath. This action prevents the person’s mind from wandering to the anxiety-provoking stimuli.

Biofeedback Experiments

One of the experiments that pioneered the use of biofeedback in a clinical setting was conducted by Miller using white rats. Miller wanted to demonstrate that the animal was able to learn to increase the blood flow to one ear by dilating the capillaries in the ear. He needed to ensure that the animal was not using a skeletal response (“cheating”) to influence this response. For example, a human can accomplish this task by covering the ear with the palm of the hand for a period of time. Miller asked whether this could be done without a skeletal response. He administered the drug curare to the rat to incapacitate the skeletal nervous system and kept the animal alive by using an artificial respirator. He attached a sensitive thermometer, which was able to detect slight changes in temperature caused by differential blood flow, to the animal’s ear. When a slight increase in temperature was detected, the message was sent to a computer, which delivered an electrical reinforcement to the brain of the subject. This represents the same mechanism that establishes the bar-pressing response in a white rat: operant conditioning. The experiment was successful.

One of the first applications of this experiment to humans came when a woman who had suffered paralysis in an automobile accident was unable even to remain in a sitting position without her blood pressure dropping to dangerous levels. Miller and his staff assembled a biofeedback device that allowed the woman to determine the nature of her blood pressure from moment to moment. No external reinforcement (such as food) was necessary in this case; knowing that the response was therapeutic was reinforcement enough. The woman was able to learn how to raise and lower her blood pressure at will through the use of the biofeedback device. By learning to control her blood pressure (and eventually wean herself off the biofeedback machine), she was able to become more productive and do some tasks on her own.

Biofeedback Applications

The concept of biofeedback, then, can be generalized to learning to control any of the visceral responses to accomplish a healthier state. As society’s stressors increase, many of the visceral responses can cause clinical problems. Among the most common are headache symptoms, muscular (tension) and vascular (migraine). By using electromyography (EMG) biofeedback, a person can monitor the muscle tension in the forehead and learn to decrease the tension by obtaining constant auditory feedback. By the same token, thermal biofeedback machines can monitor blood flow to the cranial arteries and can teach a person how to reduce the volume of blood to this area and redirect it to the periphery of the body. This change may help other problems associated with migraines, such as Raynaud disease, in which the extremities are cold because of lack of blood flow.

The galvanic skin response
is one of the most common responses used to measure the degree of anxiety and stress. In fact, it is one of the measures in a lie detector, which assumes that when one lies, anxiety increases automatically. The galvanic skin response can be brought under control using biofeedback methods. For example, if a pregnant woman is anxious about the upcoming birth, she can receive constant feedback from a galvanic skin response biofeedback apparatus and learn to lower the galvanic skin response by attending to the machine. As she learns to accomplish this, she can apply these skills on her own and eventually use them during the birth process.

Yet another application of biofeedback in coping with stress has been the use of the technique in controlling brain waves through electroencephalography (EEG) biofeedback. EEG measures the electrical output of the brain, which may be brought under voluntary control by biofeedback and relaxation. It is thought that the brain’s alpha wave (eight to thirteen cycles per second) represents the resting brain. By having a machine monitor the amount of alpha activity from moment to moment through electrodes on the scalp, a person can learn to increase alpha production and thereby reduce stress.

Another common biofeedback technique is heart rate variability biofeedback, which helps the person to reduce high blood pressure and improve lung function. Evidence suggests that biofeedback may also be beneficial in managing gastrointestinal conditions such as irritable bowel syndrome and chronic pain.

Use of Relaxation Techniques

Prior to and during biofeedback training, various relaxation techniques are employed to help with the procedure. This arrangement actually leads to an academic problem: which technique is working and to what degree? The use of Jacobson’s progressive muscle relaxation with asthmatic children and adults helped to reduce the frequency and severity of the incidents. One of the common problems that arises from increased stress is insomnia; the use of Jacobson’s technique has proved useful in combating this problem in several documented cases. Autogenic phrases—phrases used by the therapist to help the client while relaxing and performing biofeedback (for example, “Your hands feel heavy and warm”)—are often employed with biofeedback as well. For muscular disorders, phrases such as “My leg is heavy” can be used. For cardiac problems, a common phrase is “My heartbeat is calm and regular.”

Meditation has been shown to produce an increase in alpha-wave activity, as has biofeedback. Practitioners of yoga focus on a phrase or word (mantra) and exclude everything else. The nervous system shows evidence of reduced stress and arousal. A variety of businesses have used meditation programs for their employees and have realized improved health and raised productivity.

Implications for the Field of Psychology

The ability to achieve voluntary control over autonomic nervous system responses to help cope with stressors is a valuable skill. The area of biofeedback has important implications for both the theoretical and clinical sides of the field of psychology. First, it is traditionally thought that classical conditioning deals with the “involuntary” nervous system responses, while instrumental conditioning mediates the “voluntary” skeletal responses. "Classical conditioning" refers to learning that occurs by contiguously pairing two stimuli, whereby the second stimulus comes to yield a response similar to the first; it is traditionally thought to be successful with involuntary responses mediated by the autonomic nervous system. Because biofeedback deals with visceral autonomic nervous system reactions and is basically a form of instrumental conditioning, this traditional dichotomy must be brought into question. Biofeedback, a phenomenon of the second half of the twentieth century, remains a relatively new field. Biofeedback techniques ultimately aim toward bringing unconscious, previously uncontrolled body responses into conscious awareness to control them therapeutically. It is a wonderful example of the interaction of the mind and body and the complicated dilemma of how and when they interact.

Biofeedback therapy invariably uses other therapies, such as relaxation and meditation, in the clinical setting. This situation naturally raises the questions of whether and to what degree biofeedback, relaxation, meditation, and their interactions are responsible for changes in the condition of the client. Many experiments are being conducted to determine the answers to these questions, and the results have been equivocal. It is also important to know what type of feedback, what type of feedback schedule, and what additional therapies are indicated for various problems.

The control of stress-related disorders without drugs or surgery is obviously a desirable goal, and biofeedback, relaxation, and meditation seem to hold some promise in this field for certain types of cases. The applications seem extensive. Hypertension, insomnia, sexual dysfunction, cardiac arrhythmias, asthma, and gastrointestinal disorders are but a few of the problems that have been addressed so far, with varying degrees of success. The degree of success of biofeedback and relaxation as coping strategies for dealing with stress is not yet clear. The results so far, however, are promising and are spawning much research.

Bibliography

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