Research Findings Biofeedback: Three Decades of "Little" Breakthroughs Excerpted from the "Mind-Body Connection," The Center for

Mind/Body Medicine This is the first of a series of occasional articles on research findings in an important area of mind-body medicine. Some of the most important "breakthroughs" in the field of biofeedback have come not from one definitive study but from th e accumulation of numerous studies over many years. Rather than focusing only on the latest published articles, we felt it important to place the field of biofe edback in its historical context. Back in the 1960s when experimental psychologist Neal Miller first demonstrated that the autonomic nervous system could be trained to alter some bodily processe s, it was thought biofeedback would change the world. Miller's discovery uproote d the prevailing paradigm, that the autonomic, or visceral, nervous system was b asically "dumb" and beyond voluntary control. At the time, some scientists predi cted that biofeedback eventually would allow patients to "take a fully active an d direct role in literally learning not to be sick" (Dienstfrey, 1991). Over the next three decades, some 3,000 articles and 100 books on biofeedback we re published. And although the research has not uncovered the kind of "unified field" original ly hoped for, biofeedback has been shown to be an effective treatment for dozens of specific ailments. These include bronchial asthma, drug and alcohol abuse, a nxiety, tension and migraine headaches, cardiac arrhythmias, essential hypertens ion, Raynaud's disease/syndrome, fecal and urinary incontinence, irritable bowel syndrome, muscle reeducation, hyperactivity and attention deficit disorder, epi lepsy, menopausal hot flashes, chronic pain syndromes, and anticipatory nausea a nd vomiting associated with chemotherapy. While biofeedback has been used succes sfully to treat some psychological and mental disorders, it seems to work best w ith patients in which physiological processes are relevant (Futterman & Shapiro, 1986). The most common forms of biofeedback today make use of instruments to "feed back " information about such bodily processes as muscle tension (EMG feedback), skin temperature (thermal feedback), brain waves (EEG feedback) and respiration. By watching the monitoring device, patients can adjust their thinking and other men tal processes in order to control bodily processes. In some cases, subjects lear n by trial and error what kind of thinking or behavior affects those processes. In other cases, subjects are taught specific methods, such as relaxation or imag ery, which it is believed will have an impact on bodily functions. One of the most exciting areas of biofeedback research today is the use of alpha -theta brainwave training. This therapy has proven effective in the treatment of various disorders, including chemical dependence, post-traumatic stress disorde r, depression, anxiety, multiple personality, panic and eating disorders. Drs. E ugene Peniston and Paul Kulkosky's (1989, 1990, 1991) pioneering work showed tha t training chronic alcoholics to increase the lower-frequency alpha and theta br ain waves, while controlling the higher frequency beta waves, resulted in signif icantly less depression, less craving for alcohol and less relapse. (The alpha b rain wave has been associated with a tranquil, serene state, while the theta wav e corresponds to a deeper meditative state.) The researchers' treatment protocol includes 6-8 weeks of thermal biofeedback an d autogenic training, followed by 30 sessions of evoked images of personal chang e and alpha-theta EEG biofeedback. The sessions are performed twice a day, five days a week.

The results of the therapy have been nothing short of remarkable--80 percent sho rt-term effectiveness, with ongoing studies tracking the long-term results. The training resulted not only in decreases in alcoholic behavior (relapse, cravings , etc.) but changes in a wide range of dysfunctional personality factors (Penist on & Kulkosky, 1990). The training even affected blood chemistry: serum Beta-end orphin levels increased in patients who completed alpha-theta brain wave trainin g (Peniston & Kulkosky, 1989). What accounts for these changes? The current theories behind alpha-theta brainwa ve training are documented in an excellent article by Jonathan D. Cowan, Ph.D. i n the Megabrain Report: The Journal of Mind Technology (Vol. 2, No. 3). Cowan su ggests that the power of the imagery instructions given prior to the EEG trainin g, in which patients rehearse new intentions and positive alternatives, should n ot be underestimated. "These images of personal change are experienced in a rela xed state, followed closely by the effect induced by alpha-theta biofeedback, wh ich is usually very pleasant. This forms an association between the images and p leasant effect which is repeated 30 times throughout the course of therapy.... T he power of [the] ... training may be partly due to inputting images and suggest ions in such a way that they bypass the conscious mind, thereby benefiting from the lack of interference from adult disbelief and disempowerment." Other researchers have used a treatment protocol similar to Peniston's with equa lly good results. A couple of clinicians have added another twist patients do th e EEG brainwave training together in a group setting. The supportive element in group process has long been a key factor in alcoholism treatment (12-step and ot her groups). But the use of brain wave training in a group has raised interestin g questions about whether people can actually influence each other's brain waves . Certainly "mob psychology" indicates that people are capable of thinking and a cting quite differently while in a group than when alone. But how that relates t o brain chemistry remains a mystery. In the mind-body self-regulation groups run by the Center for Mind-Body Medicine , participants regularly use biofeedback techniques together in the group. The p rogram's director, Mary Lee Esty, believes the group practice has a supportive, reinforcing effect that enhances individual, at-home practice. The impact of bio feedback and mind-body self-regulation techniques within a small group setting m erits further study. The Center plans to begin such a research project in 1996. Increasingly sophisticated measurement devices may expand biofeedback's possibil ities in the future. For example, a number of biofeedback experts, including Est y in Washington, D.C., are pioneering a new form of EEG training that uses light stimulation to increase the range and variability of patients' dominant brain f requencies. The treatment is proving successful with trauma victims whose brains have gotten "stuck" in a pattern of predominantly slow waves. EEG slowing is as sociated with symptoms such as anxiety, depression, irritability, fatigue, hyper activity, distractibility, mood swings, confusion and disorganization. More and more, biofeedback researchers are discovering that the key to wellness is not figuring out how to achieve a perpetual "theta state." The key is brain f lexibility, or as Cowan writes, teaching [a person] "to perceive and control a n umber of different transitions among his own unique state-contexts, which differ among themselves in the amounts of each of these rhythms that they produce. Say s Esty, "The objective is balance." Clearly, the entire field of biofeedback is as ripe for new discovery as it was 30 years ago. According to Alternative Medicine: Expanding Medical Horizons, bio feedback deserves more broad clinical trials on large patient populations to det ermine its effectiveness. "A major reason why many patients like biofeedback tra ining is that...it puts them in charge, giving them a sense of mastery and selfreliance over their illness and health," states the report to the National Insti

tutes of Health. "Such an attitude may play a crucial role in the lower health c are costs seen in patients after learning biofeedback skills." Auditory Beats in the Brain by Gerald Oster Scientific American, October 1973 Slow modulations called binaural beats are perceived when tones of different fre quency are presented separately to each ear. The sensation may show how certain sounds are processed in the brain. If two tuning forks of slightly different pitch are struck simultaneously, the r esulting sound waxes and wanes periodically. The modulations are referred to as beats; their frequency is equal to the difference between the frequencies of the two original tones. Binaural beats have been widely regarded as a mere curiosity. A recent textbook on hearing does not mention them at all. Yet the measurement of binaural beats c an explain the processes by which sounds are located -- a crucial aspect of perc eption. It is possible that hormonally induced physiological behavior changes ma y be made apparent by measuring the binaural-beat spectrum. The Mind Revealed by Marcia Barinaga SCIENCE, Vol. 249 (1989) Some neuroscientists think that recently discovered oscillations of electrical p otential at 40 hertz hold the key to how the brain assembles sense impressions i nto a single object. Has Wolf Singer uncovered the cellular basis of consciousness? Some neuroscienti sts think he may have, although Singer himself stops short of such a bold claim. It was in his recording that Singer noticed that, for short periods of less than half a second, the field potential was oscillating--alternately rising and dipp ing--with a frequency of 40 hertz. Those oscillations reflected a synchronous, r epeating pattern of current flow into the neurons in the vicinity of the electro de. And since such an ion flow often triggers an action potential, that meant th at many of those neurons must be firing action potentials together, in brief pha se-locked synchrony. "We think of consciousness as occurring in different ways," Crick says. "You can be conscious of pain; you can be self-conscious; you can be conscious of hearin g, seeing, even of making plans. Our hypothesis is that all of these may have so mething in common and therefore why not study the easiest one? We think the easi est one is visual awareness." One of the features that makes the 40 hertz oscillations attractive as a mediato r of visual awareness, Koch says, is that their time scale corresponds with that of attention flitting from one object to another. The neurons typically stay ph ase-locked for several hundred milliseconds, which would allow them to make and break their liaisons in roughly the same period that a person's attention moves from one subject to the next. As different subjects compete for attention, different sets of neurons may set u p oscillations, Koch proposes. One wins momentarily and attention is briefly foc used. Then that oscillation fatigues and attention is directed elsewhere. "It's a very beautiful picture," he enthuses. As the experimentalists pursue the oscil lations in their biological context, the theorists are cheering from the sidelin es. Von der Malsburg, for one, is eagerly awaiting the next round of results. "W

olf Singer and the others are onto something extremely important," he says. "If this experimental-theoretical story materializes even further, it will open the door to a completely new era." A New Theory of Consciousness HEALTH/SCIENCE, New Mexican April 7, 1995 For scientists who study the human brain, even its simplest act of perception is an event of astonishing intricacy. 40 Hz brain activity may be a kind of binding mechanism, said Dr. Rodolfo Llinas , a professor of neuroscience at New York University. Llinas believes that the 40-cycle-per-second wave serves to connect structures i n the cortex where advanced information processing occurs, and the thalamus, a l ower brain region where complex relay and integrative functions are carried out. The Brain Wave Frequencies of Health by Jean Charles Genet, Director of The National Center for Integrative Medicine and The National Research Center for Chronic Fatigue The ability of the brain to enter and maintain certain frequencies while sleepin g may determine the level of health a person experiences. Individuals suffering from the symptoms of Chronic Fatigue (waking up tired, str essed, experiencing symptomatic pain, depression, confused thinking, memory loss , headaches, nervous stomach, or having sleeping disorders, etc.) were solicited by the National Research Center for Chronic Fatigue in Denver, Colorado. Patients were measured by electroencephalographic (EEG) brain wave recordings. I t was revealed that certain frequencies could not be maintained. Although, as wi th any group, the response to one measured frequency is different from one perso n to the next, the overall response from those tested showed seven frequencies t o be consistently weaker. These seven frequencies seemed to be guide posts within the subconscious that le ad the brain into and out of specific functions necessary for the nightly recons tructive process of the body to occur while in the sleep cycle. The weakness or inability to reach and maintain these frequencies related directly to the specif ic symptom or ailment experienced. Reduction in Levels of Exhaustion Those who suffer from Chronic Fatigue exhaust very easily. When moved to 4HZ the se individuals showed marked improvement in the length of time between the occur rence of exhaustion after certain exercises were completed. Solutions to Problems At 7.5 HZ subjects who before suffered from confused thinking reported an ease a t finding solutions to troublesome problems after a re-evaluation was conducted. Less Effect From Symptoms Those individuals whose ailments have manifested into the fourth stage of Chroni c Fatigue, where some form of disease is apparent, experienced a release from th e negative sensation of their symptoms when moved into 1.5HZ.