Biofeedback: Biofeedback-Assisted Relaxation Training
Biofeedback is a technique that uses medical equipment to monitor physiological measures like heart rate, blood pressure, and muscle tension. This feedback is provided to patients to help them learn to lower stress levels and relax certain body functions through techniques like deep breathing and muscle relaxation. Biofeedback aims to make patients aware of their physical responses, teach them control over these responses, and help them generalize relaxation skills to daily life. It is most commonly used as an adjunct to relaxation training to treat conditions like migraines that are linked to stress and tension.
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Biofeedback: Biofeedback-Assisted Relaxation Training
Biofeedback is a technique that uses medical equipment to monitor physiological measures like heart rate, blood pressure, and muscle tension. This feedback is provided to patients to help them learn to lower stress levels and relax certain body functions through techniques like deep breathing and muscle relaxation. Biofeedback aims to make patients aware of their physical responses, teach them control over these responses, and help them generalize relaxation skills to daily life. It is most commonly used as an adjunct to relaxation training to treat conditions like migraines that are linked to stress and tension.
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BIOFEEDBACK
Biofeedback is the practice of applied psycho-physiology. It involves the use of
sensitive, medical grade equipment to obtain physiological measures of heart rate, heart rate variability, pulse height, skin temperature, electomyographical muscle activity, blood pressure, skin conductance, respiration rates, and even levels of oxygen saturation or carbon dioxide levels in the breath. Biofeedback measurements are not only noted by the clinical psychophysiologist, they are fed back to the patient in a meaningful ay. !atients are taught to loer blood pressure and heart rate, improve heart rate variability "vagal tone# and reduce their stress levels using a variety of techniques. Biofeedback-Assisted Relaxation Training : Biobehavioral treatment also includes training children to use active coping skills. $hese coping skills include not only the aforementioned positive lifestyle habits and adherence to preventive and abortive medication regimens, but also biofeedback- assisted relaxation training (BART). %elaxation training usually involves one or more of the folloing techniques& progressive muscle relaxation, diaphragmatic or deep breathing, and guided imagery. !rogressive muscle relaxation training involves alternate tensing and relaxing of various muscle groups throughout the body. Its goal is to teach the child the contrast beteen tension and relaxation via systematic physical manipulation. 'iaphragmatic or deep breathing involves systematic inhalation and exhalation. (gain, the child learns the relationship beteen tension and relaxation by attention to breathing, hich produces somatic changes in a systematic fashion. )uided imagery relies on a cognitive means of producing a state of relaxation. In this procedure, the child visuali*es a pleasant scene or favored activity, such as playing in the oods or taking a ride on a favorite amusement park attraction, to achieve a state of relaxation. %elaxation training is used most often ith children + years of age or older. ,oever, ith developmentally appropriate ad-ustments to the training procedures, relaxation training procedures, especially those emphasi*ing imagery, have been used successfully ith preschool-age children and intellectually challenged children. In practice, because of the cognitive, attentional, social, and emotional demands of the treatment, the use of standard relaxation training protocols is best suited for older children. .hildren need to be able to understand the rationale of using relaxation to combat feeling such severe pain. $hey also must be able to concentrate on their bodily sensations for an extended time and have the social and emotional maturity to learn ho to both manage stress and sustain the practice necessary to acquire and maintain relaxation. It is quite rare for a child to experience problematic effects from learning relaxation. /ne exception involves a child becoming emotionally upset because of the novelty of the sensation of relaxation. $his sensation might be especially problematic for a child ho has experienced a number of traumatic events that are relived in a state of relaxation. Biofeedback is most often used as an ad-unct to relaxation training to address migraine. Instrumentation is used to monitor the physiologic effects of relaxation and0or to facilitate the learning of relaxation skills by providing visual and0or audio feedback about actual changes in otherise invisible bodily processes. 1hen described in this manner, it is evident that biofeedback itself is not a treatment modality. %ather, biofeedback instrumentation is used to enhance self-control and relaxation training. $herefore, in our biobehavioral approach to care, this technique is referred to as BART. Biofeedback instrumentation is used in the relaxation treatment process to accomplish three goals: (1) to make the child aare of ph!sical responses" (#) to teach control of these responses" and ($) to transfer or generali%e these skills to use in e&er!da! life. 'Biofeedback' is a form of complementar! and alternati&e medicine ((A)) hich in&ol&es measuring a sub*ect+s bodil! processes such as blood pressure" heart rate" skin temperature" gal&anic skin response (seating)" and muscle tension and con&e!ing such information to him or her in real-time in order to raise his or her aareness and conscious control of the related ph!siological acti&ities. By providing access to physiological information about hich the user is generally unaare, biofeedback allos users to gain control over physical processes previously considered automatic. %esearch has demonstrated that biofeedback can help in the treatment of many diseases and painful conditions. It has shon that e have more control over so-called involuntary bodily function than e once though possible. But it has also shon that nature limits the extent of such control. 2cientists are no trying to determine -ust ho much voluntary control e can exert. Biofeedback can be used by coaches and educators to help people function better and by therapists as part of treatment for many disorders including anxiety, urinary incontinence, fecal incontinence and constipation, migraine headaches, tension headaches, (',', ('', pain from improperly functioning muscles in the -as, shoulders, back, etc., irritable boel syndrome, phobias, non-cardiac chest pain, high and lo blood pressure, epilepsy, paralysis and other movement disorders, stress, and many other types of problems. 2pecialists ho provide biofeedback training range from psychiatrists and psychologists to dentists, internists, nurses, physical therapists, and other mental health professionals. 3ost psychotherapists rely on many other techniques in addition to biofeedback. !atients usually are taught some form of relaxation exercise. 2ome learn to identify the circumstances that trigger their symptoms. $hey may also be taught ho to avoid or cope ith these stressful events. 3ost are encouraged to change their habits, and some are trained in special techniques for gaining such self-control. Biofeedback is not magic. It cannot cure disease or by itself make a person healthy. It is a tool, one of many available to health care professionals. It reminds physicians that behavior, thoughts, and feelings profoundly influence physical health. (nd it helps both patients and doctors understand that they must ork together as a team. ,atients+ Responsibilities : Biofeedback places unusual demands on patients. $hey must examine their day-to-day lives to learn if they may be contributing to their on distress. $hey must recogni*e that they can, by their on efforts, remedy some physical ailments. $hey must commit themselves to practicing biofeedback or relaxation exercises every day. $hey must change bad habits, even ease up on some good ones. 3ost important, they must accept much of the responsibility for maintaining their on health. ,o 'oes Biofeedback 1ork 4 3ost patients ho benefit from biofeedback are trained to relax and modify their behavior. 3ost scientists believe that relaxation is a key component in biofeedback treatment of many disorders, particularly those brought on or made orse by stress. $heir reasoning is based on hat is knon about the effects of stress on the body. In brief, the argument goes like this& 2tressful events produce strong emotions, hich arouse certain physical responses. 3any of these responses are controlled by the sympathetic nervous system, the netork of nerve tissues that helps prepare the body to meet emergencies by 'flight or fight.' $he typical pattern of response to emergencies probably emerged during the time hen all humans faced mostly physical threats. (lthough the 5threats5 e no live ith are seldom physical, the body reacts as if they ere& $he pupils dilate to let in more light. 2eat pours out, reducing the chance of skin cuts. Blood vessels near the skin contract to reduce bleeding, hile those in the brain and muscles dilate to increase the oxygen supply. $he gastrointestinal tract, including the stomach and intestines, slos don to reduce the energy expensed in digestion. $he heart beats faster, and blood pressure rises. 6ormally, people calm don hen a stressful event is over especially if they have done something to cope ith it. 7or instance, imagine your on reactions if you8re alking don a dark street and hear someone running toard you. 9ou get scared. 9our body prepared you to ard off an attacker or run fast enough to get aay. 1hen you do escape, you gradually relax. If you get angry at your boss, it8s a different matter. 9our body may prepare to fight. But since you ant to keep your -ob, you try to ignore the angry feelings. 2imilarly, if on the ay home you get stalled in traffic, there8s nothing you can do to get aay. $hese situations can literally may you sick. 9our body has prepared for action, but you cannot act. Individuals differ in the ay they respond to stress. In some, one function, such as blood pressure, becomes more active hile others remain normal. 3any experts believe that these individual physical responses to stress can become habitual. 1hen the body is repeatedly aroused, one or more functions may become permanently overactive. (ctual damage to bodily tissues may eventually result. Biofeedback is often aimed at changing habitual reactions to stress that can cause pain or disease. )an! clinicians belie&e that some of their patients and clients ha&e forgotten ho to relax. -eedback of ph!sical responses such as skin temperature and muscle tension pro&ides information to help patients recogni%e a relaxed state. The feedback signal ma! also act as a kind of reard for reducing tension. What is biofeedback ? Biofeedback is a treatment technique in hich people are trained to improve their health by using signals from their on bodies. !hysical therapists use biofeedback to help stroke victims regain movement in paraly*ed muscles. !sychologists use it to help tense and anxious clients learn to relax. 2pecialists in many different fields use biofeedback to help their patients cope ith pain. .hances are you have used biofeedback yourself. 9ou8ve used it if you have ever taken your temperature or stepped on a scale. $he thermometer tells you hether you8re running a fever, the scale hether you8ve gained eight. Both devices 5feed back5 information about your body8s condition. (rmed ith this information, you can take steps you8ve learned to improve the condition. 1hen you8re running a fever, you go to bed and drink plenty of fluids. 1hen you8ve gained eight, you resolve to eat less and sometimes you do. .linicians reply on complicated biofeedback machines in somehat the same ay that you rely on your scale or thermometer. $heir machines can detect a person8s internal bodily functions ith far greater sensitivity and precision than a person can alone. $his information may be valuable. Both patients and therapists use it to gauge and direct the progress of treatment. 7or patients, the biofeedback machine acts as a kind of sixth sense hich allos them to 5see5 or 5hear5 activity inside their bodies. /ne commonly used type of machine, for example, picks up electrical signals in the muscles. It translates these signals into a form that patients can detect& It triggers a flashing light bulb, perhaps, or activates a beeper every time muscles gro more tense. If patients ant to relax tense muscles, they try to slo don the flashing or beeping. :ike a pitcher learning to thro a ball across a home plate, the biofeedback trainee, in an attempt to improve a skill, monitors the performance. 1hen a pitch is off the mark, the ballplayer ad-usts the delivery so that he performs better the next time he tries. 1hen the light flashes or the beeper beeps too often, the biofeedback trainee makes internal ad-ustments hich alter the signals. $he biofeedback therapist acts as a coach, standing at the sidelines setting goals and limits on hat to expect and giving hints on ho to improve performance. The Beginnings of Biofeedback $he ord 5biofeedback5 as coined in the late ;<=>s to describe laboratory procedures then being used to train experimental research sub-ects to alter brain activity, blood pressure, heart rate, and other bodily functions that normally are not controlled voluntarily. (t the time, many scientists looked forard to the day hen biofeedback ould give us a ma-or degree of control over our bodies. $hey thought, for instance, that e might be able to 5ill5 ourselves to be more creative by changing the patterns of our brainaves. 2ome believed that biofeedback ould one day make it possible to do aay ith drug treatments that often cause uncomfortable side effects in patients ith high blood pressure and other serious conditions. $oday, most scientists agree that such high hopes ere not realistic. %esearch has demonstrated that biofeedback can help in the treatment of many diseases and painful conditions. It has shon that e have more control over so-called involuntary bodily function than e once though possible. But it has also shon that nature limits the extent of such control. 2cientists are no trying to determine -ust ho much voluntary control e can exert. How is Biofeedback Used Today? .linical biofeedback techniques that gre out of the early laboratory procedures are no idely used to treat an ever-lengthening list of conditions. $hese include& 3igraine headaches, tension headaches, and many other types of pain 'isorders of the digestive system ,igh blood pressure and its opposite, lo blood pressure .ardiac arrhythmias "abnormalities, sometimes dangerous, in the rhythm of the heartbeat# %aynaud8s disease "a circulatory disorder that causes uncomfortably cold hands# ?pilepsy !aralysis and other movement disorders 2pecialists ho provide biofeedback training range from psychiatrists and psychologists to dentists, internists, nurses, and physical therapists. 3ost rely on many other techniques in addition to biofeedback. !atients usually are taught some form of relaxation exercise. 2ome learn to identify the circumstances that trigger their symptoms. $hey may also be taught ho to avoid or cope ith these stressful events. 3ost are encouraged to change their habits, and some are trained in special techniques for gaining such self-control. Biofeedback is not magic. .t cannot cure disease or b! itself make a person health!. .t is a tool" one of man! a&ailable to health care professionals. .t reminds ph!sicians that beha&ior" thoughts" and feelings profoundl! influence ph!sical health. (nd it helps both patients and doctors understand that they must ork together as a team.
$he value of a feedback signal as information and reard may be even greater in the treatment of patients ith paraly*ed or spastic muscles. 1ith these patients, biofeedback seems to be primarily a form of skill training like learning to pitch a ball. Instead of atching the ball, the patient atches the machine, hich monitors activity in the affected muscle. 2troke victims ith paraly*ed arms and legs, for example, see that some part of their affected limbs remains active. $he signal from the biofeedback machine proves it. $his signal can guide the exercises that help patients regain use of their limbs. !erhaps -ust as important, the feedback convinces patients that the limbs are still alive. $his reassurance often encourages them to continue their efforts. Types of Biofeedback Instrumentation : /lectrom!ogram -- $his is the most common form of biofeedback measurement. (n ?3) uses electrodes or other types of sensors to measure muscle tension. By the ?3) alerting you to muscle tension, you can learn to recogni*e the feeling early on and try to control the tension right aay. ?3) is mainly used as a relaxation technique to help ease tension in those muscles involved in backaches, headaches, neck pain and grinding your teeth "bruxism#. (n ?3) may be used to treat some illnesses in hich the symptoms tend to orsen under stress, such as asthma and ulcers. ,eripheral 0kin Temperature -- 2ensors attached to your fingers or feet measure your skin temperature. Because body temperature often drops hen a person experiences stress, a lo reading can prompt you to begin relaxation techniques. $emperature biofeedback can help treat certain circulatory disorders, such as %aynaud8s disease, or reduce the frequency of migraines. $he physiological process behind the temperature drop associated ith the stress response is quite simply vasoconstriction "blood vessels narroed by the smooth musculature in their alls# 1al&anic skin response training -- 2ensors measure the activity of your seat glands and the amount of perspiration on your skin, alerting you to anxiety. $his information can be useful in treating emotional disorders such as phobias, anxiety and stuttering. $his is the method most commonly used by a lie detector machine. /lectroencephalogram -- (n ??) monitors the activity of brain aves linked to different mental states, such as akefulness, relaxation, calmness, light sleep and deep sleep. $his is the least common of the methods, mostly due to the cost and availability of an ??) machine. Origins of Biofeedback : 6eal 3iller, a psychology !h.' and neuroscientist ho orked and studied at 9ale @niversity, is generally considered to be the father of modern-day biofeedback. ,e came across the basic principles of biofeedback hen doing animal experimentation conditioning the behavior of rats. ,is team found that, by stimulating the pleasure centers of the rats8 brains ith electricity, it as possible to train rats to control phenomena ranging from their heart rates to their brainaves. @ntil that point, it as believed that bodily processes like heart rate ere under the control of the autonomic nervous system and not responsive to conscious effort. )a*or modalities of Biofeedback .nstrumentation Electromyograph -- (n electromyograph, or ?3) is the one of the most commonly used modalities in biofeedback treatment. (n ?3) in a biofeedback setting typically uses electrodes in order to measure muscle action potentials. $hese action potentials result in muscle tension. $he patient can learn to recogni*e the ay tension sub-ectively feels by using the ob-ective ?3) readings, and as a result learn to control the muscle tension. ?3) is used as a relaxation technique to ease tension in the muscles causing backaches, neck pain, $3', incontinence, and tension, migraine, and cluster headaches. ?3) is also used in the process of muscle rehabilitation, such as in cases of paralysis resulting from .erebral !alsy, stroke, and incomplete spinal cord lesions. i) Feedback thermometer -- Thermal Biofeedback $his test measures skin temperature and can indicate problems ith blood flo. 2ensors attached to your fingers or feet measure your skin temperature. 2tress leads to a fall in body temperature because arteries constrict causing blood flo to be limited to necessary organs and extremities. $his reduced blood flo leads to problems like migraines and %aynaudAs disease "an ailment in hich blood circulation can not reach fingers or toes#. @sing thermal biofeedback can help individuals recogni*e these symptoms and train their body to vasodilate. ( thermistor attached to the sub-ect8s digits or eb dorsum measures the sub-ect8s skin temperature. Because there is a correlation beteen a drop in body temperature and the patient8s experience of stress, a lo temperature reading indicates the need to begin relaxation techniques. $emperature biofeedback can also help in treating certain circulatory disorders, such as %aynaud8s disease, and can reduce the frequency and severity of migraines. $he physiological processes hich are being trained in this modality are vasoconstriction and vasodialation, here blood vessel si*e is a result of the contraction and relaxation of smooth musculature in the vessel alls. $he mechanism being trained in arming exercises is a beta-adrenergic vasodilator mechanism. 0kin Temperature 2hat is it3 Skin Temperature is a measure of a person's state of relaxation. We have all touched someones hand that felt very cold. Some people always seem to have warm hands. Learning to increase your finger tip temperature is called Temperature training. This is one of the most basic techniques used in iofeedback. 4o do !ou do it3 ( 2kin $emperature measuring instrument is used to continuously monitor the temperature. ( small sensor is attached to a finger or toe using tape or a velcro band. If finger arming is being carried out the sensor can be lightly held beteen thumb and finger, hen using this be aare that the reading can be increased for a short time by holding the sensor tighter but this can not be done for long. (t the beginning the person is asked to think about arming their hand "or foot# getting armer. Bisuali*ation helps, but the effective visuali*ation varies from person to person. ?xamples are thinking of having your hands in front of a arm fire or in a arm muff. 1ithin a short time the $emperature reading ill start to change. $his gives positive feedback that the person is doing the correct thing. 6ote this should be carried out in a arm room , C>deg . or =D 7 for best results. /ften hen someone first tries this they try to hard and the reading ill go don, then if they relax the reading ill start to rise. 1ith practice the amount of temperature rise ill increase. !ractice needs to be done for at least C> min. a day an tice a day is better. It is useful to record the start and finish levels to get some idea of improvements over time. 2hat is it used for3 $emperature training is an effective ay of learning relaxation and increasing the blood flo to the extremities. $he 2kin $emperature reading is an indication of autonmic response and can be used in psychotherapy for giving information on a persons resistance. $emperature training is a very good ay of helping a person become more in tune ith their body. In conditions involving chronic pain e.g. %heumatoid arthritis, temperature training helps to reduce the pain and improve a person8s general outlook. It is used as an effective treatment for %aynaud8s disease, high blood pressure, migraine headaches, //2 "%2I# and for general relaxation. What equipment do I need? $he only equipment is a thermometer. (n electronic model is best as it ill allo changes of >.;'eg to be seen. Being able to see small changes is important hen starting out as initial changes may be small. It must also update the reading at least every C seconds. Beare that most lo cost thermometers only update the reading every ;> seconds and this is too slo to be useful in Biofeedback. $he sensor should not be to large as the larger the sensor the sloer the response. Basic lo cost temperature trainers typically only have a digital readout, but are a very useful basic tool and home trainer. 3ore advanced instruments measure 2kin $emperature and display it as a sound and bargraph. .omputer systems often have a selection of displays ii) Electroencephalograph (n electroencephalograph, or ??) monitors the activity of brain aves. $hese brain aves correspond to different mental states, such as akefulness "Beta aves#, relaxation "(lpha aves#, calmness "$heta aves#, and light sleep and deep sleep "'elta aves#. ??)s are useful in the treatment of anxiety and (','. (n ??) monitors the activity of brain aves linked to different and deep mental states, such as akefulness, relaxation, calmness, light sleep and deep sleep. $he brain emits electrical signals of various frequencies. /nly a fe of these aves can be tied to specific disorders or mental states. $he folloing are classification of brain aves& (lpha, Beta ,$heta, and 'elta aves. $his is the least common of the methods, mostly due to the cost and availability of an ??) machine. Biofeedback 5seful for /pileps! Biofeedback, short form for biological feedback, is basically the monitoring of internal body states. 1atching and listening to sensitive instruments that mirror psycho- physiological processes helps you understand body processes hich you are not normally aare of. (n electronic instrument detects, amplifies, and then gives you immediate information "feedback# about your on conditions, such as& brain ave activity "??) or electroencephalograph#. $his feedback guides you as you become more in touch ith your mind and body. $his aspect of Biofeedback is very useful in case of ?pilepsy. $his is because people ith epilepsy have brains that continuously misfire "not -ust during sei*ures#. $his is one ay neurologists make a diagnosis. $his continuous misfiring often involves only a fe brain cells, no bigger than the point of a pin. 1hen brain cells surrounding the misfiring or damaged cells are activated, a sei*ure may occur. $here ere several researches conducted to demonstrate the relevance of biofeedback for epilepsy.2ince the ;<+>As researchers have demonstrated in over E> controlled studies that a special form of brain ave biofeedback - no called neurofeedback - safely and effectively trains the brain to stabili*e its activity. $he treatment has been used successfully ith all types of sei*ure disorders. /ften the effects are permanent. In training sessions, computeri*ed biofeedback instrumentation detects and displays the brain aves on a computer screen. $he program allos for simultaneous inhibition of slo ave ??) "the brain ave activity associated ith sei*ure disorders# hile reinforcing mid-range frequencies associated ith preventing sei*ures. 3uch of the learning takes place simply ith practice hile receiving positive reinforcement from the computer. (fter enough training sessions the aura rate goes don and so does the sei*ure rate. 6o one knos exactly hat occurs as e learn to normali*e the brain ave activity "produce ??) patterns hich donAt trigger sei*ures#, but it orks. !atients ho have sei*ures triggered by anxiety or stressful situations may benefit from this therapy, in addition to their sei*ure medications. iii) Photoplethysmograph !hotoplethysmographs, or !!)s, in biofeedback are used to measure peripheral blood flo, heart rate, and heart rate variability",%B#. $o measure ,%B, !!)s measure the varying distances beteen heart beats, also knon as the interbeat interval "IBI#. $his data guides users in finding a breathing pattern that increases their variability. !!)s are also helpful in biofeedback treatment for some types of cardiac arrhythmias. 4eart rate &ariabilit! 4eart rate &ariabilit! "4R6# is a measure of the beat-to-beat variations in heart rate. It is usually calculated by analy*ing a time series of beat-to-beat intervals from the ?.), of beat-to-beat intervals derived from an arterial pressure tracing or of beat-to-beat intervals derived from a pulse ave signal measured by means of a photoplethysmograph "!!)#. Barious measures of heart rate variability have been proposed, hich can roughly be subdivided into time domain, frequency domain and geometric measures. ,%B is regarded as an indicator of the activity of autonomic regulation of circulatory function, although controversy exists over hether this is an accurate metric for analy*ing cardiovascular autonomic control. (lterations "mostly reductions# in ,%B have been reported to be associated ith various pathologic conditions such as hypertension, hemorrhagic shock, and septic shock. It also has some utility as a modest predictor of mortality after an acute myocardial infarction. Time domain measures ( simple example of a time domain measure is the calculation of the standard deviation of beat-to-beat intervals. In other ords the time intervals beteen heart beats can be statistically analy*ed to obtain information about the autonomic nervous system. /ther time domain measures include root mean square of the differences beteen heart beats "r322'#, 66E> or the number of normal to normal complexes that fall ithin E> milliseconds, and p66E> or the percentage of total number beats that fall ith E> milliseconds. -re7uenc! domain measures ( common frequency domain method is the application of the discrete 7ourier transform to the beat-to-beat interval time series. $his provides an estimation of the amount of variation at specific frequencies. 2everal frequency bands of interest have been defined in humans. ,igh 7requency band ",7# beteen >.;E and >.F ,*. ,7 is driven by respiration and appears to derive mainly from vagal activity or the parasympathetic nervous system. :o 7requency band ":7# beteen >.>F and >.;E ,*. :7 derives from both parasympathetic and sympathetic activity and has been hypothesi*ed to reflect the delay in the baroreceptor loop. Bery :o 7requency band "B:7# band beteen >.>>GG and >.>F ,*. $he origin of B:7 is not ell knon, but it had been attributed to thermal regulation of the body8s internal systems. @ltra :o 7requency "@:7# band beteen > and >.>>GG ,*. $he ma-or background of @:7 is day0night variation and therefore is only expressed in CF- hour recordings. $he ratio of lo-to-high frequency spectra poer ":70,7# is used as an index of sympathetic to parasympathetic balance of heart rate fluctuation, but this remains controversial because of still little understanding of the :7 component, hich may be affected by centrally generated brainstem rhythms, baro-reflex influences, as ell as both sympathetic and parasympathetic inputs, etc. 1eometric measures $he most commonly used non-linear method of analy*ing heart rate variability is the !oincarH plot. $he !oincarH plot fits heart rate data points to an ellipse that is fitted to to intersecting lines. 2'; and 2'C, or the standard deviations of the data points have also been applied in the context of !oincarH analysis. i&) Pneumograph ( pneumograph measures abdominal0chest movement "as hen breathing#, usually ith a strain gauge. $hey are used to detect breathing rate, and correct ineffective breathing patterns such as thoracic breathing, reverse breathing, and apnea. $hey are also often used in con-unction ith a !!) in ,%B training. v) Capnometer ( capnometer measures end-tidal ./C ith an infrared detector. (ll biofeedback training that employs the use of a capnometer aims at normali*ing end-tidal ./C at EI. .apnometric biofeedback is useful in the treatment of hyperventilation syndrome. 'uring hyperventilation, end-tidal ./C loers from a normal level of EI to C.EI. Respiration -eedback $his test measures breathing rate and allos patients to learn to control conditions such as anxiety, asthma, and hyperventilation. vi) Hemoencephalography ,emoencephalography, or ,?) biofeedback is a method of functional infrared imaging that indirectly measures neural activity in the brain. $here are to knon types of ,?), passive infrared "pI%# and near infrared "nI%#.6ear infrared ,?) measures the differences in color of light reflected back through the scalp, based on the relative amount of oxygenated and unoxygenated blood in the brain. !assive infrared measures the amount of heat that is radiated by the scalp at various locations of interest. 4emoencephalograph! ",?)# is a type of functional near-infrared imaging "f6I%# of the level of neuronal activity in the brain. /ne method of doing this takes advantage of the translucent nature of the cranium and differences in absorption rates of various avelengths of light for oxygenated vs. unoxygenated blood. $o different lights placed on the scalp are shone into the brain and the relative differences beteen the amount of each light that is reflected back out through the scalp provide a relative measure of changes in blood oxygen level. (nother method simply involves placing an infrared sensor on the scalp to detect the amount of heat radiation at that spot. (lthough each method detects changes in level of cerebral activity, one as it as reflected in oxygen level, the other as reflected by thermal level, and although each method is used for similar biofeedback purposes, e.g. treatment of migraine headaches, the pattern of results are somehat different at times. vii) Electrodermograph In electrodermograph training, sensors measure the activity of a patient8s seat glands. $he amount of electrical resistance measured on the skin indicates the level of anxiety. $his information can then be used to treat emotional disorders such as phobias, anxiety and stuttering. $he best-knon use of this method of biofeedback is in polygraph machines. )alvanic skin response meters are currently gaining popularity in hypnotherapy and psychotherapy practices, so subtle physiological changes that indicate emotional arousal can be more easily detected. 1al&anic skin Response Training $his technique is similar to that of a :ie 'etecting 3achine. $he activity of your seat glands and amount of perspiration on your skin is measured by the sensors, thus alerting you to anxiety. $his knoledge is useful in treating emotional disorders like stuttering, phobias and anxiety. 1al&anic skin response 1al&anic skin response ")2%#, also knon as electrodermal response "?'%#, ps!chogal&anic reflex "!)%#, or skin conductance response "2.%#, is a method of measuring the electrical resistance of the skin. $here has been a long history of electrodermal activity research, most of it dealing ith spontaneous fluctuations. 3ost investigators accept the phenomenon ithout understanding exactly hat it means. $here is a relationship beteen sympathetic activity and emotional arousal, although one cannot identify the specific emotion being elicited. $he )2% is highly sensitive to emotions in some people. 7ear, anger, startle response, orienting response and sexual feelings are all among the emotions hich may produce similar )2% responses. ,ractice )2% is conducted by attaching to leads to the skin, and acquiring a base measure. $hen, as the activity being studied is performed, recordings are made from the leads. $here are to ays to perform a )2% - in active )2%, current is passed through the body, ith the resistance measured. In passive )2%, current generated by the body itself is measured. 5ses )2% measurement is one component of polygraph devices and is used in scientific research of emotional arousal.)2% measurement is also becoming commonplace in hypnotherapy and psychotherapy practice here it can be used as a method of detecting depth of hypnotic trance prior to suggestion therapy commencing. 1hen traumatic material is experienced by the client "for example, during hypnoanalysis#, immediate changes in galvanic skin response can indicate that the client is experiencing emotional arousal. It is also used in behavior therapy to measure physiological reactions such as fear. 2kin conductance is also a factor in some modern electronics to measure the activation of touchscreen devices. $his is notable as many of these devices that use capacitive screens cannot be used hile earing gloves as the sensors are not triggered by the lo conductivity of rubber or leather. 2kin .onductance ")2%# biofeedback instruments are the first step in bringing hypnosis from the nether regions of the occult into the domain of science. $he use of these instruments provides an empirical basis for hypnosis, transforming it from a personal art to an ob-ective science. In the past hypnosis has been a much misunderstood and frequently suspect technique of therapeutic treatment. 2tage hypnotists, using highly responsive sub-ects and a vaudeville shomanship approach have given the field an undeserved aura of mystery and chicanery. 3eanehile legitimate practitioners have sometimes achieved miracle cures hich have defied scientific explanation. 2ince the hypnotic process has never been substantiated through scientific invertigation, the technique has remained controversial. 2ome professionals and laymen are enthusiastic, if not fanatical, about its value hile others have flatly re-ected it. 1ith the use of 2kin .onductance biofeedback instrumentation some aspects of the hypnotic process can be made scientifically ob-ective thereby increasing the general credibility of the process. !rimary values of 2kin .onductance biofeedback instruments are& ;. ,elping clients to reach deeper levels of relaxation C. !roviding hypnotists ith ob-ective indications of relaxation depth G. 'emonstrating the efficacy of a characteristic induction process ith a particular client F. Indicating hether or not suggestions given are acceptable to the client. 2econdary values are & ;. 2haring responsibility ith the client for entering a state of hypnosis. C. Increasing the confidence of the client in the hypnotist and the hypnotic process. G. ?stablishing a professional image of the hypnotist. F. Improving the training and expertise of hypnotists. $raditional hypnosis consists of three phasesJ the induction, the reprogramming suggestions, and the return. $he purpose of the induction is to quiet the body, mind and emotions of the sub-ect so that in the second phase full attention is brought to focus on the issue of concern. 1hen the person is quiescent, suggestions are apt to have the greatest impact. )iven a successful induction, the suggestions or affirmations ork best hen& ;. the critical faculty of the client is absent C. the client focuses on one belief, attitude, or idea G. the client can clearly visuali*e a ne situation, habit pattern, skill or hatever is relevant. 1hile these conditions are neither necessary nor sufficient for successfully reprogramming the mind, most hypnotists ork toards establishing them during the hypnotic process. 3oreover, these are general conditions useful for nearly any learning activity, and hypnosis usually involves some learning on the part of the sub-ect. In the initial phase hypnosis has some similarity to mediation techniques. ,ypnotists sek to quiet the body and mind before implanting suggestion. 3ediators also begin by quieting the body and mind. In a sense, hypnosis could be called 5 applied meditation5. /ne difference beteen meditation and hypnosis is that hypnosis often deals ith the notion of a subconscious mind hile meditation aims to contact a superconscious mind. 1ith instrumentation and feedback, both client and hypnotist are aare of hat is happening and both can ork together to loer the client8s stress level. It is not a question of the 5ill5 of the hypnotist against the 5ill5 of the client, both cooperate. $he client takes responsibility for their on conditionJ they do not surrender their ill to the hypnotist. $his helps to bypass the issue of trust and the hole process goes smoother and more efficiently. By taking inexpensive biofeedback instruments home, clients can practice more effectively, ith greater interest, and ith ob-ective indications of their success. $he client can learn to relax more rapidly and more deeply. $he hynotist can learn hich induction method orks best for that person and can tell hen they are deeply relaxed. $here is no need to test for depth by challenges- the hypnotist can simply look at the meter or note the pitch of the sound. $his leaves him free to concentrate on preparing and administering hypnotic prescription or otherise orking ith the client hile they are in a deeply relaxed state. 2ometimes the hypnotist may not ish to have the tone of the instrument audible. It may disturb the client or interfere ith tape recording. ( 2kin .onductance instrument hich has a meter has a control to turn off the sound. 1hen the sub-ecthas successfully dropped the pitch or loered the meter needle, the operator can reset the controls to a higher level again and request the sub-ect to go even deeper into relaxation. $his deepening process can be repeated several times during the course of a typical induction. 1hen the client is sufficiently relaxed the next phase of the process can begin. 'uring the induction my associates and I suggest that the person let their body go to sleep, hile their conscious mind remain aare and alert. $his seems to be a more accurate ay of stating hat happens. /f course the sub-ect does not go into any kind of trance state. $ypically they experience a sensation of floating ithin the body. 1e use the term 5nexus5 to talk ith them about that condition. In nexus, hich denotes a tie or link, the sub-ect can either connect to his subconscious body-mind or his superconscious mind. 6exus is not an all or none state, rather it is more like a progressive condition. 7rom the point of poer hich e call nexus, a person can direct their subconscious or ask for guidance from their superconscious. .omplete programs ork ith all three minds and in this sense hypnosis ought to be considered as a state of greater akefulness rather than sleep. 1hen a person is in the nexus condition the skin conductance ill continue to reflect changes. 2ometimes the slightest thought, orry, or distraction ill produce a skin conductance reaction. If the hypnotist gives a suggestion hich is not acceptable to the sub-ect the skin conductance ill often indicate this by a pitch increase. (ny comment by the hypnotist hich has any emotional charge ill be indicated as a skin conductance change and the hypnotist can either explore the matter immediately or note it and ask the sub-ect about it after the session. In reprogramming the subconscious mind via the conscious mind, e ask the sub-ect to visuali*e hat he or she ants to happen. Bisuali*ation has been found to help imprint the ne program. 1ith biofeedback, both sub-ect and hypnotist have an indication of the clarity of the visuali*ation, and a means of training for improvement. 0kin (onductance )onitor 0tress - The final frontier @ncontrolled stress prevents you from reaching your full potential. ,eadaches, phobias, hypertension, obesity, sleeplessness, chronic pain, smoking another conditions are all linked to and aggravated by chronic stress. 2tress is a part of everyday life, and it keeps many people from functioning at their optimum level because they do not kno ho stressed they are or ho to control it. Biofeedback is a idely used and medically accepted technique for teaching control of stress. %elaxation releases energy, alloing the energy being asted on stress to be channeled into more productive activity. :earn to control your stress, in your on home, using Biofeedback. $he proven most effective ay to control stress and learn true relaxation. 7eel better, sleep better, helps to achieve your personal goals. $he Biofeed 2kin .onductance monitor measures your body8s reaction to emotional and physical stress ith great sensitivity, and gives 8feedback8 on changes from moment to moment in your tension level by means of a tone and meter reading. It lets you monitor and control your stress by amplifying tiny stress related changes in y or skin into a sound and movement on the built in meter. 2imply rap the to sensors around your finger tips and you ill see and hear ho different events affect your stress level. Kust thinking about something stressful ill cause a change. (s your stress increases so does the tone and the meter needle moves up the scale. $here are various techniques of Biofeedback that are used by $herapists and !ractitioners so as to bring about relief to patients. $hese techniques help the patient to identify !sychophysical symptoms and gain control over physical processes previously considered automatic. viii) Electromyogram (EMG) $his is the most common form of biofeedback measurement. (n ?3) uses electrodes or other types of sensors to measure muscle tension. $he most common muscles that biofeedback practitioners ill use are the frontalis "the froning muscle in your forehead#, the masseter "-a muscle#, and the trape*ium "the shoulder muscles that hunch hen youAre stressed#. 1hen the electrodes pick up on muscle tension, the machine gives you a signal, such as a colored light or sound. 1hen the ?3) alerts you to muscle tension, you can learn to recogni*e and control the tension right aay. It helps ease tension in those muscles involved in backaches, headaches, neck pain and grinding your teeth "bruxism#. It is also useful for treating stress related illnesses such as asthma and ulcers. /lectrom!ograph! (/)1) $his test helps individuals recogni*e symptoms before and during muscle tension, in-ury, and pain. $he sensors help measure the activity of the nerves that manage muscles. T!pes of biofeedback and their uses Biofeedback orks by using electronic instrumentation to monitor specific physiological activities-often unconscious-and habits of your body and then feeds it back to you. 1ith this information, you can change those patterns of behaviour or eliminate them completely. It is helpful in curing chronic, benign problems because it loers the use of drugs and visits to the doctor. 2ome of the equipment it uses are& /lectrom!ogram (/)1): $his equipment uses electrodes or other kinds of sensors to measure muscle tension. /nce you are alerted to muscle tension, you can begin to recogni*e your on feelings early on and try to control the tension. 1ith ?3), you can learn to relax your muscles that bring on backaches, headaches, neck pain and bruxism or grinding of teeth, apart from asthma and ulcers. Temperature biofeedback: 1ith sensors attached to your fingers or feet, you can measure your skin temperature. 1hen your temperature falls at stressful times, a lo reading can make you begin relaxation techniques. Besides, biofeedback can also help treat %aynaudAs disease and reduce the frequency of migraines. 1al&anic skin response training: 1ith the help of sensors, you can also measure the activity of your seat glands and the amount of seat on your skin, hich can alert you to become anxious. 1ith this information, you can treat emotional disorders such as phobias, anxiety and stuttering. /lectroencephalogram (//1): $he activity of the brain aves linked to different mental states, such as akefulness, relaxation, calmness, light sleep and deep sleep, can be measured by an ??). Biofeedback can also be helpful in these conditions& It can reduce or negate the need for medication. It can help in those conditions here medication hasnAt. By providing measurable feedback, it allos you to be in charge of your on healing and monitoring your on progress. It can decrease your medical costs.