Kaplan & Sadock’s Pocket Handbook of Clinical Psychiatry

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Kaplan & Sadock’s Pocket Handbook of Clinical Psychiatry

TABLE 29-6. Biofeedback Applications Condition Effects Asthma

Both frontal EMG and airway resistance biofeedback have been reported as producing relaxation from the panic associated with asthma, as well as improving airflow rate. Specific biofeedback of the ECG has permitted patients to lower the frequency of premature ventricular contractions.

Cardiac arrhythmias

Fecal incontinence and enuresis The timing sequence of internal and external anal sphincters has been measured with triple-lumen rectal catheters providing feedback to incontinent patients for them to reestablish normal bowel habits in a relatively small number of biofeedback sessions. An actual precursor of biofeedback dating to 1938 was the sounding of a buzzer for sleeping enuretic children at the first sign of moisture (the pad and bell). Grand mal epilepsy A number of EEG biofeedback procedures have been used experimentally

to suppress seizure activity prophylactically in patients not responsive to anticonvulsant medication. The procedures permit the patient to enhance the sensorimotor brain wave rhythm or to normalize brain activity as computed in real-time power spectrum displays. EEG biofeedback procedures have been used on children with attention deficit hyperactivity disorder to train them to reduce their motor restlessness. A variety of specific (direct) and nonspecific biofeedback procedures—­ including blood pressure feedback, galvanic skin response, and foot-hand thermal feedback combined with relaxation procedures—have been used to teach patients to increase or decrease their blood pressure. Some follow-up data indicate that the changes may persist for years and often permit the reduction or elimination of antihypertensive medications. The most common biofeedback strategy with classic or common vascular headaches has been thermal biofeedback from a digit accompanied by autogenic self-suggestive phrases encouraging hand warming and head cooling. The mechanism is thought to help prevent excessive cerebral artery vasoconstriction, often accompanied by an ischemic prodromal symptom, such as scintillating scotomata, followed by rebound engorgement of arteries and stretching of vessel wall pain receptors. High levels of EMG activity over the powerful muscles associated with bilateral temporomandibular joints have been decreased by means of biofeedback in patients who are jaw clenchers or have bruxism. Mechanical devices or an EMG measurement of muscle activity displayed to a patient increases the effectiveness of traditional therapies, as documented by relatively long clinical histories in peripheral nerve-muscle damage, spasmodic torticollis, selected cases of tardive dyskinesia, cerebral palsy, and upper motor neuron hemiplegia. Cold hands and cold feet are frequent concomitants of anxiety and also occur in Raynaud syndrome, caused by vasospasm of arterial smooth muscle. A number of studies report that thermal feedback from the hand, an inexpensive and benign procedure compared with surgical sympathectomy, is effective in about 70% of cases of Raynaud syndrome. Muscle contraction headaches are most frequently treated with two large active electrodes spaced on the forehead to provide visual or auditory information about the levels of muscle tension. The frontal electrode placement is sensitive to EMG activity in the frontalis and occipital muscles, which the patient learns to relax.

Hyperactivity

Idiopathic hypertension and orthostatic hypotension

Migraine

Myofascial and temporomandibular joint pain

Neuromuscular rehabilitation

Raynaud syndrome

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Tension headaches

ECG, electrocardiogram; EEG, electroencephalogram; EMG, electromyogram.