Biofeedback

***Disclaimer: This blog is not meant to be used as legal or medical advice.  It is written as my person perspective on how medical professionals could blend western medicine with other modalities***

Today, I'd like to talk about biofeedback.  This is an approach to healing that connects the patient with a monitoring system.  As unconscious processes are relayed to the patient in real time, the patient makes conscious adjustments to make the unconscious process come into a healthier range.  What does this look like?  A simple example would be heart rate.  A biofeedback practitioner connects a heart monitor to a patient who suffers from anxiety.  The machine reflects back to the patient any changes in heart rate that occur as it is happening.  The biofeedback practitioner might guide the patient to do things that will cause relaxation such as meditation or deep breathing exercises.  The patient knows what actions work based on real time feedback.
This is fascinating to me, because if it's real, if it works, we are literally circumventing the mental blocks that keep us from actively regulating the autonomic functions of the brain.  It is harnessing the power of the mind to facilitate better health directly.
As a side note I should warn you, I ran into some websites that have a very different idea about what biofeedback is.  According to their bio resonance theory, a machine reads the weak electromagnetic energies that radiate from the cells of the body.  It then filters positive energies out of the negative energies and enhances the positive ones to send back to the body.  This "feeds back" the positive "bio" energy.  I did not find any clinical research on this type of biofeedback.  So as they say...Buyer beware.

People have used biofeedback to treat many kinds of bowel disturbances and urinary incontinence, mental disorders like stress and anxiety, pain, asthma, hypertension, and muscular dysfunction such as those caused by stroke.
There are currently accessible devices that claim to be biofeedback tools for home use.  Some of these devices remind me of a toy that was available in stores a few years ago.  Basically, the child wears a device around their head that can pick up brainwaves.  When certain brainwaves were detected, the connected apparatus would cause a ball to move around as if the child were using some kind of... shall we call it... force?  If only they had something like that when I was a kid!
It took me a while to research this particular modality.  As scientifically based as it is, it was difficult to find a study that showed efficacy compared to placebo.  Obviously, a patient would be aware of whether they were operating under biofeedback or not, so it would be difficult to create a scenario where the control arm might think they were getting a similar treatment.
I did manage to find a study that did their best to do just that.  An article from the journal Neuropsychopharmacology discussed a small trial that used biofeedback to control moderate to severe depression.  These patients were already on medication for depression, so the treatment would be adjunct to primary treatment.  Each group had neurobiofeedback.  One group was directed to focus on a position in the brain that dealt with emotion while the other was directed to focus on a position that dealt with imaging.  Both groups were coached to think of positive images as one method for manipulating the biofeedback, but were given freedom to choose whatever method they wished.  Interestingly, they found that both groups improved equally and to a degree that demonstrated superiority over the recognized placebo effect.  Because of this trial, they determined that the connection between visualization and emotion were too closely connected to make a significant enough sham.  However, they did determine that the efficacy was greater than what would be expected from a standard placebo effect.  This was compounded by the fact that the treatment was secondary to medication.  Typically, primary treatment has the most significant affect while adjunct therapy tends to see smaller results.  Neither arm of this trial demonstrated this phenomenon. 
Although several other trials I read demonstrated efficacy, this was the only one I found that recognized the need to blind patients.  Although I found trials for all kinds of diseases, the control arms had no additional treatment to compare with a strong placebo.
On the bright side, all of these trials saw significant improvement in the treatment arms.  Even if they don't necessarily prove it works better than placebo, they do demonstrate efficacy.  Unfortunately, there are services and products that claim to be biofeedback, but are not.  As health care professionals, we are in a position to help guide patients to buying proper equipment or going to the right service providers.  Many biofeedback practitioners can be found through the Association for Applied Psychophysiology and Biofeedback.  Their website is www.aapb.org.
How does this fit in with western medicine?  This seems to be a good treatment option for people who experience sub-therapeutic results - particularly for depression.  I think another great fit would be patients who experience urinary incontinence following prostatectomy.  It's possible that it might benefit patients refractory to therapy for bowel disorders, asthma, hypertension, and pain - though I would advise caution for these disease states without looking at the evidence first.
That's all I have for now on biofeedback.  If you have any comments, concerns, or questions, you can email me at integratedpharmacist@gmail.com.  If you are enjoying this podcast, please leave a rating and review wherever you get your podcast services; and be sure to tell a friend who you think would be interested.  Thank you for joining me and stay tuned for next week's edition of The Integrated Pharmacist!

References:
Mehler DMA, Sokunbi MO, Habes I, et al.  Targeting the affective brain—a randomized controlled trial of real-time fMRI neurofeedback in patients with depression.  Neuropsychopharmacology 2018;43:2578–2585.