Clinical Efficacy of Biofeedback Therapy – Efficacious for anxiety, panic attacks, depression and agoraphobia. Also significant decreases in the STAI and drops in the Psychosomatic Symptom Checklist including chronic pain.
a. In a comparison with a no-treatment control group, alternative treatment group, or sham (placebo) control utilizing randomized assignment, the investigational treatment is shown to be statistically significantly superior to the control condition, or the investigational treatment is equivalent to a
treatment of established efficacy in a study with sufficient power to detect moderate differences,
b. The studies have been conducted with a population treated for a specific problem, for whom inclusion criteria are delineated in a reliable, operationally defined manner, and
c. The study used valid and clearly specified outcome measures related to the problem being treated, and
d. The data are subjected to appropriate data analysis, and
e. The diagnostic and treatment variables and procedures are clearly defined in a manner that permits replication of the study by independent researchers, and f. The superiority or equivalence of the investigational treatment has been shown in at least two independent research settings.
Clinically significant improvements of anxiety, panic attacks, depression and agoraphobia
Multiple case studies have demonstrated clinically significant outcomes with carefully screened and thoroughly assessed participants for various forms of anxiety-related disorders. There are also several treatment-only group studies with moderate sample sizes, demonstrating positive results of various forms of biofeedback that were often combined with other behavioral interventions.
A few well-controlled, randomized studies have shown biofeedback to be equivalent to other relaxation and self-control methods for reducing anxiety while it is occasionally shown to be superior to another intervention. Most show biofeedback (EMG, GSR, thermal, or neurofeedback) to be roughly equivalent to progressive relaxation or meditation.
Lehrer, Carr, Sargunaraj, and Woolfolk (1994) evaluated the hypothesis that biofeedback is most effective when applied in the same modality as the disorder (autonomic feedback for ANS disorders, EMG feedback for muscular disorders, etc.).
Two studies showed biofeedback’s efficacy in reducing anxiety without making comparisons with other relaxation techniques. Hurley and Meminger (1992) used frontal EMG biofeedback with 40 subjects trained to criterion and assessed anxiety over time using the State-Trait Anxiety Inventory
(STAI). State anxiety improved more than trait anxiety.
Wenck, Leu, and D’Amato (1996) trained 150 seventh- and eighth-graders with thermal and EMG feedback and found significant reduction in state and trait anxiety.
Roome and Romney (1985) compared progressive muscle relaxation to EMG biofeedback training with 30 children and found an advantage for biofeedback; however, Scandrett, Bean, Breeden, and Powell (1986) found some advantage of progressive muscle relaxation over EMG biofeedback in
reducing anxiety in adult psychiatric inpatients and outpatients.
Rice, Blanchard, and Purcell (1993) studied reduction in generalized anxiety by comparing groups given EMG frontal feedback, EEG alpha-increase feedback, and EEG alpha-decrease feedback to two control conditions (a pseudo-meditation condition and a wait-list control). All treatment groups had comparable and significant decreases in the STAI and drops in the Psychosomatic Symptom Checklist.
The alpha-increasing biofeedback condition produced one effect not found with the other treatment conditions: a reduction in heart-rate reactivity to stressors. Similar results were obtained by Sarkar, Rathee, and Neera (1999), who compared the generalized anxiety disorder response to pharmacotherapy and to biofeedback; the two treatments had similar effects on symptom reduction.
Hawkins, Doell, Lindseth, Jeffers, and Skaggs (1980) concluded, from a study with 40 hospitalized schizophrenics, that thermal biofeedback and relaxation instructions had an equivalent effect on anxiety reduction.
However, Fehring (1983) found adding GSR biofeedback to a Benson-type relaxation technique reduced anxiety symptoms more than relaxation alone.
Vanathy, Sharma, and Kumar (1998), applying EEG biofeedback to generalized anxiety disorder, compared increased alpha with increased theta. The two procedures were both effective in decreasing symptoms.
In a recent case study, Hammond (2003) reported on two cases using EEG biofeedback for OCD. Clinically significant improvements for both participants were reported. In a single case study (Goodwin & Montgomery, 2006) of a 39-year-old male with panic disorder and agoraphobia, electrodermal biofeedback was combined with CBT, graded exposure. They reported a complete cessation of panic attacks, a remission of agoraphobia, and a clinically significant reduction in depression.
In a study by Gordon, Staples, Blyta, and Bytyqi (2004) a total of 139 PTSD postwar high school students were provided a six-week program of biofeedback, meditation, drawings, autogenics, guided imagery, genograms, and breathing techniques. No control group was used, but they reported a significant reduction immediately after treatment and at follow up.
In a two-treatment group comparison study (n=50) of anxiety in individuals with chronic pain, Corrado, Gottlieb, and Abdelhamid (2003) reported a significant improvement in anxiety and somatic complaints in the group that received biofeedback of finger temperature increase and muscle tension reduction when compared to a pain education group.
In an RCT study of 87 participants, Bont, Castilla, and Maranon (2004) presented the outcome of three intervention programs applied to fear of flying: a reattributional training-based program, a mixed-exposure procedure, and finally a biofeedback training program in order to change psychophysiological responses. A fourth group of wait-list controls were also assessed. They found a significant reduction in anxiety for the treatment groups when compared to the control group of no treatment.
In another RCT study of imipramine and imipramine plus biofeedback, Coy, Cardenas, Cabrera, Zirot, and Claros (2005). Found the biofeedback group plus medication (n=18) was significantly improved compared to the medication-only group (n=14). From a group of 312 high school students in Shanghai, Dong and Bao (2005) recruited 70 students who met criteria for high levels of anxiety and assigned 35 students to a group who were treated with biofeedback and 35 to a group of no-treatment controls. They reported a significant improvement in anxiety, somatization, and depression in the treatment group when compared to the controls.
In conclusion, biofeedback of various modalities is effective for anxiety reduction. It is often found to compare favorably with other behavioral techniques and occasionally found to be superior to those and medication alone.
Bont, J.I.C., Castilla, C.D.S., & Maranon, P.P. (2004). Comparison of three fear of flying therapeutic programs. Psicothema, 16(4), 661-666.
Corrado, P., Gottlieb, H., & Abdelhamid, M.H. (2003). The effect of biofeedback and relaxation training on anxiety and somatic complaints in chronic pain patients. American Journal of Pain Management, 13(4), 133-139.
Coy, P.C., Cardenas, S.J., Cabrera, D.M., Zirot, G.Z., & Claros, M.S. (2005). Psychophysiological and behavioral treatment of anxiety disorder. Salud Mental, 28(1), 28-37.
Dong, W., & Bao, F. (2005). Effects of biofeedback therapy on the intervention of examination-caused anxiety. Chinese Journal of Clinical Rehabilitation, 9(32), 17-19.
Fehring, R.J. (1983). Effects of biofeedback-aided relaxation on the psychological stress symptoms of college students. Nursing Research, 32(6), 362-366.
Goodwin, E.A., & Montgomery, D.D. (2006). A cognitive-behavioral, biofeedback-assisted relaxation treatment for panic disorder with agoraphobia. Clinical Case Studies, 5(2), 112-125.
Gordon, J.S., Staples, J.K., Blyta, A., & Bytyqi, M. (2004). Treatment of posttraumatic stress disorder in postwar Kosovo high school students using mind-body skills groups: A pilot study. Journal of Traumatic Stress, 17(2), 143-147.
Hammond, D.C. (2003). QEEG-guided neurofeedback in the treatment of obsessive-compulsive disorder. Journal of Neurotherapy, 7(2), 25-52.
Hawkins, R.C., II, Doell, S.R., Lindseth, P., Jeffers, V., & Skaggs, S. (1980). Anxiety reduction in hospitalized schizophrenics through thermal biofeedback and relaxation training. Perceptual & Motor Skills, 51(2), 475-482.
Hurley, J.D., & Meminger, S.R. (1992). A relapse-prevention program: Effects of electromyographic training on high and low levels of state and trait anxiety. Perceptual and Motor Skills, 74(3, Pt. 1), 699-705.
Lehrer, P.M., Carr, R., Sargunaraj, D., & Woolfolk, R.L. (1994). Stress management techniques: Are they all equivalent, or do they have specific effects? Biofeedback & Self Regulation, 19(4), 353-401.
Rice, K.M., Blanchard, E.B., & Purcell, M. (1993). Biofeedback treatments of generalized anxiety disorder: Preliminary results. Biofeedback & Self-Regulation, 18(2), 93-105.
Roome, J.R., & Romney, D.M. (1985). Reducing anxiety in gifted children by inducing relaxation. Roeper Review, 7(3), 177-179.
Sarkar, P., Rathee, S.P., & Neera, N. (1999). Comparative efficacy of pharmacotherapy and biofeedback among cases of generalised anxiety disorder. Journal of Projective Psychology & Mental Health, 6(1), 69-77.
Scandrett, S.L., Bean, J.L., Breeden, S., & Powell, S. (1986). A comparative study of biofeedback and progressive relaxation in anxious patients. Issues in Mental Health Nursing, 8(3), 255-271.
Vanathy, S., Sharma, P.S.V.N., & Kumar, K.B. (1998). The efficacy of alpha and theta neurofeedback training in treatment of generalized anxiety disorder. Indian Journal of Clinical Psychology, 25(2), 136-143.
Wenck, L.S., Leu, P.W., & D’Amato, R.C. (1996). Evaluating the efficacy of a biofeedback intervention to reduce children’s anxiety. Journal of Clinical Psychology, 52(4), 469-473.