August 24th, 2012

Biofeedback used as tool in practice

As the field of psychology moves towards integration with the medical world, more professionals are seeking ways to link psychological theory and practice with medical science.

One tool that has been around for nearly a century, but only started gaining traction in the past 40 years, is biofeedback therapy. According to Inna Khazan, Ph.D., a Harvard-trained clinical psychologist and certified biofeedback specialist, biofeedback has great potential in both the medical and psychological fields. Teaching clients how to alter their physical responses to stress, she specializes in the treatment of medically related disorders, anxiety, depression and pain conditions.

An instructor of psychology at Harvard Medical School, Khazan teaches biofeedback at the Cambridge Health Alliance, where she herself was trained. She hopes to see more of her colleagues look to the innovative and empirically-proven techniques to work with clients. She spoke with New England Psychologist’s Catherine Robertson Souter about her work and the potential she sees in the field.

Q: What is biofeedback? Can you give us a quick overview?

A:  Biofeedback is a way to learn to regulate your body’s physiological response. We measure things like muscle tension, breathing, heart rate, heart rate variability, skin temperature and skin conductance. People see the feedback on the computer screen and learn how to modify these reactions.

It gives people a way to regulate their autonomic nervous system – the part of the nervous system that is typically considered to be outside our control. We do have quite a few ways to influence that –  both in the moment and skills that people can use to retrain their autonomic nervous systems to respond differently.

Q: Who do you treat?

A: I see clients who have a variety of medical issues, things like migraines, tension headaches, hypertension, chronic pain, Reynaud’s disease, and TMJ. These are psychophysiological disorders, medical problems that have a psychological component to them. We use a combination of mind-body therapies to alleviate the disorders. I’m not just helping people to cope with the issues, but helping to reduce the symptoms themselves.
Q: What are some of the tools you use to change the autonomic response?
A: There is a lot research showing what kind of biofeedback works with what kind of disorder. For example, with migraines, temperature biofeedback has been shown to be very effective. A lot of people with migraines have cold hands or feet on a regular basis. I teach them how to warm up their hands, through breathing or imagery or through proprioceptive sensations. We get to what works for each person. Then they practice those skills. Regular practice of these skills will minimize severity and frequency of the migraines.

I also work with people on heart rate variability – the time interval between each heart beat. High heart rate variability is an indicator of overall cardiac health. There is also a large amount of research showing an association between psychophysiological disorders and heart rate variability.

So people learn how to increase their heart rate variability in my office and they go home and practice. It becomes like strength training for the autonomic nervous system. It modifies the way your sympathetic nervous system and your parasympathetic nervous system respond in the moment.

Q: This sounds like everyone should do it. Do you practice it yourself?

A: I no longer hook myself up to the biofeedback equipment because I no longer need it but I practice these skills on a daily basis. I do think it could benefit pretty much anybody. Your nervous system could always use a little help in stressful moments and this is a way to do it preventatively.
Q: What other specialties do you focus on in your clinical practice?

A: I see a lot of people with anxiety, some with depression. The primary intervention I use is a mindfulness-based psychotherapy. Mindfulness is a way to be in the moment, to accept it, letting go of judgment.
Q: How are people referred to you?

A: Many find me through my Web site but I also get referrals from several primary care doctors and from the pain clinics at Tufts and Massachusetts General Hospital. I have some colleagues who refer to me for biofeedback for their patients who need it. This tends to work really well because it is a good way to focus on the issue at hand.

This is not new research but it has not gotten much attention either in the public realm or within psychology.
It has been out there for quite a while. Biofeedback has its roots in Eastern traditions and it has been around since probably the early 20th century. It became more popular in the 1970s and there has been a lot of research done on it since then. There has been a gradual increase in popularity.

Since biofeedback requires specialized equipment, it is not the most accessible tool for therapists. Maybe that is part of reason it’s not as popular as other behavioral or psychotherapy techniques. But it is certainly not new. There is a lot of research showing that it is effective treatment for certain disorders and in many situations it is as effective as medication and sometimes more effective for some people.

Q: Are there many other psychologists in the area who do this?

A: No, there really are not. In the Boston area, I can count them on two hands.

Proper training is necessary and not widely available. There is only one center in Boston accredited to teach biofeedback – Cambridge Health Alliance, where I teach. I think psychologists are becoming more familiar with biofeedback.

In the last couple years there have been more people who are interested in taking the training who are not part of CHA.
Q: Where can someone learn more?

A: A good place to start is the Association for Applied Psychophysiology and Biofeedback (  I am also in the process of finishing up a book about biofeedback and ways to implement treatment. It will be published in the spring by Wiley Publishing (“The Clinical Handbook of Biofeedback: A Guide for Training and Practice with Mindfulness.”)

Q: What credentials are needed to practice?

A: There is a board certification but if you have a license in psychology, you don’t need a certificate. I do encourage it, though, to make sure that you are getting the proper training. You do have to be a licensed clinician. Having a biofeedback certificate is not a license to practice.
Q: Would you like to see more psychologists using biofeedback in their practice?

A: Therapists often shy away from more physiologically-based stuff but biofeedback sits so well with psychotherapy and with what psychologists and therapists are already so well trained to do. It’s not a far reach to incorporate biofeedback into your practice and it can be tremendously helpful to a lot of people.

By Catherine Robertson Souter

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