In this post I’ll talk about and define both traditional Biofeedback as well as Mindfulness-Based Biofeedback (MBB). Many people have heard of biofeedback but have never had the experience of receiving it as a treatment themselves. Truly, I wish that everyone had access to this treatment; I really see it as training in how to recover from stress and, at least for MBB, how to prevent chronic stress through improving responses to feelings & thoughts. Pretty universal, right?
Let’s start with traditional Biofeedback. Biofeedback is a treatment for stress-related mental & physical health conditions that utilizes measures of psychophysiology (traditionally used modalities include muscle tension (EMG), skin temperature, skin conductance, respiration & heart rate variability (and EEG / brain waves, although this has become its own field of Neurofeedback). It is traditionally an in-person treatment that often lasts from 5-20 sessions. Any biofeedback treatment requires (minimum) 20 minutes per day of home practice; that’s important to know and feel ready to commit to before starting treatment.
While the sessions are often conducted by therapists (though not only therapists), they are also more skills-based, educational and experiential than psychotherapy. Biofeedback can be used in conjunction with therapy (I do this a lot!) in some powerful ways.
Sometimes there is confusion about what biofeedback is …
It teaches you to train your body and mind, it’s not a medical examination
It works on your physiology, but it’s not a medication
Sensors go on your skin, but it’s not invasive
It’s not a provider doing something to you, it’s a totally natural treatment that you do
Traditional biofeedback has a considerable evidence base for the following stress-related conditions (the list can be much longer, but I tend to focus on what has a mountain of evidence behind it):
Tension headaches
Migraines
Anxiety / Stress
Depression
Stress-related medical conditions (e.g. stress-related hypertension, blood sugar control, IBS, asthma)
What is Mindfulness-Based Biofeedback?
If traditional biofeedback helps us recover from stress, Mindfulness-Based Biofeedback (MBB) helps us become intimately aware of the impact of our thoughts and feelings on our body’s functioning (and vice versa) with the purpose of preventing chronic stress.
Stress in the short or even medium-term is likely normal and non-damaging. The only problematic stress is chronic stress. So, what is it that converts normative stress into chronic stress?
My answer is this: the way we respond to our thoughts and feelings. If we respond to our feelings in a suppressive or avoidant manner; if we respond to our passing thoughts by perseveratively thinking (e.g. worrying, ruminating) … then we are inviting chronic stress into our lives. We are artificially converting normative stress into toxic chronic stress.
My dear colleague, Dr. Aliyah Snyder, and I (with inspiration from pioneers like Drs. Inna Khazan and Richard Gevirtz) have developed a 12-session MBB program. Dr. Snyder has deep research and neuropsychological expertise, and my background is around health psychology, biofeedback & mindfulness; together, I believe we’ve created a deeply helpful and thoughtful treatment that is truly applicable to any human wanting to improve their relationship with stress. We will be rolling this out at a clinic in Los Angeles called The Integrated Clinic (private practice clinic, open to anyone), my private practice in Redwood City CA as well as at the San Mateo Medical Center (for those with MediCal or immigrants without documentation status) and a clinic for brain health at the University of Florida. We also plan to study the protocol to evaluate its effectiveness amongst larger groups of patients.
Like traditional Biofeedback, MBB uses the same sensors / modalities and also involves learning how to recover from stress but goes further in teaching you how to change your relationship to your thoughts and feelings through lots of evidence-based techniques and fascinating real-time demonstrations about the direct impact of your thoughts and feelings on your physiology.
Here’s how our MBB program works session-by-session:
Session 1-2: A full psychophysiological assessment with personalized report on your physiology & how it responds to stress + feedback
Session 3-5: Training in physiological methods for stress recovery using respiration and heart rhythms
Session 6: Check-in about treatment / adjustments, specialized assessments as needed for each person / presenting problem
Session 7: Real-time demonstrations of the mind-body connection & introduction to mindfulness
Session 8: Deepening your ability to listen to your physiology (interoception) using your muscles and heartbeat detection
Session 9: How to skillfully respond to emotions psychophysiologically
Session 10: How to skillfully respond to thoughts psychophysiologically
Session 11: How to bring all your skills together to confront high levels of stress
Session 12: Re-assessment of psychophysiology & discussion of progress
We measure progress in a variety of ways:
Personalized goals for treatment are made collaboratively and operationalized to ensure we can determine progress
You’ll be asked to reflect on 6 of the most important aspects of health each session and receive behavioral support and achieving improvements
The health of your Autonomic Nervous System (ANS) will be measured at the beginning of each session with the hope that treatment will improve your baseline ANS functioning
You will work on any aspect of your physiology to help train it to become less reactive to stress or to improve it at baseline; for example, if you have classic signs of stress such as chronically tense muscles or cold hands, we’ll work to get your muscles to a relaxed state or to teach you to warm your hands in the face of stress
If you can avail yourself of this treatment and you’re ready to practice the techniques daily, I believe you will see benefit. While I have never received biofeedback treatment (at least formally), just giving the treatment (which involves me practicing with patients at times) has completely cleared my weekly tension headaches (parting gift from graduate school); also, some of the techniques I teach in the protocol have fundamentally changed my relationship to my body, to my stress and even how I see myself (in positive ways). It’s such a pleasure for me to offer this treatment to my patients because I see the benefit and I feel that I get to know them in a fuller way as they get to know themselves more deeply.
If you don’t have the opportunity to receive this treatment … well that’s why I write my other posts ~ so you can try some of these things at home and still receive benefit. For more professional resources, the following books from Dr. Inna Khazan (her book in particular integrates mindfulness into biofeedback practices; it also has a lot of great scientific background) and Dr. Leah Lagos (very practical & straight-forward biofeedback techniques along with emotion regulation skills) are meant for people who aren’t able to receive Biofeedback. Also, some of the benefits of MBB can be achieved through investing in a meditation group, program or app.
While Biofeedback is a very well-established treatment (50+ years), right now is an amazing time to receive this type of treatment from a professional or avail yourself of home-based training devices. Why now? Because the last 20 years (and especially the last 5) have seen an explosion of high-quality research that has helped us hone this natural modality for healing and illuminated how Biofeedback can ameliorate the functioning of multiple bodily systems (including the brain) and problems that stem from stress.