BIOFEEDBACK

Biofeedback is the practice of applied psycho-physiology. It involves the use of sensitive, medical grade equipment to obtain physiological measures of heart rate, heart rate variability, pulse height, skin temperature, electomyographical muscle activity, blood pressure, skin conductance, respiration rates, and even levels of oxygen saturation or carbon dioxide levels in the breath. Biofeedback measurements are not only noted by the clinical psychophysiologist, they are fed back to the patient in a meaningful way. Patients are taught to lower blood pressure and heart rate, improve heart rate variability (vagal tone) and reduce their stress levels using a variety of techniques.

Biofeedback-Assisted Relaxation Training :

Biobehavioral treatment also includes training children to use active coping skills. These coping skills include not only the aforementioned positive lifestyle habits and adherence to preventive and abortive medication regimens, but also biofeedbackassisted relaxation training (BART). Relaxation training usually involves one or more of the following techniques: progressive muscle relaxation, diaphragmatic or deep breathing, and guided imagery. Progressive muscle relaxation training involves alternate tensing and relaxing of various muscle groups throughout the body. Its goal is to teach the child the contrast between tension and relaxation via systematic physical manipulation. Diaphragmatic or deep breathing involves systematic inhalation and exhalation. Again, the child learns the relationship between tension and relaxation by attention to breathing, which produces somatic changes in a systematic fashion. Guided imagery relies on a cognitive means of producing a state of relaxation. In this procedure, the child visualizes a pleasant scene or favored activity, such as playing in the woods or taking a ride on a favorite amusement park attraction, to achieve a state of relaxation. Relaxation training is used most often with children 7 years of age or older. However, with developmentally appropriate adjustments to the training procedures, relaxation training procedures, especially those emphasizing imagery, have been used successfully with preschool-age children and intellectually challenged children. In practice, because of the cognitive, attentional, social, and emotional demands of the treatment, the use of standard relaxation training protocols is best suited for older children.

Children need to be able to understand the rationale of using relaxation to combat feeling such severe pain. They also must be able to concentrate on their bodily sensations for an extended time and have the social and emotional maturity to learn how to both manage stress and sustain the practice necessary to acquire and maintain relaxation. It is quite rare for a child to experience problematic effects from learning relaxation. One exception involves a child becoming emotionally upset because of the novelty of the sensation of relaxation. This sensation might be especially problematic for a child who has experienced a number of traumatic events that are relived in a state of relaxation. Biofeedback is most often used as an adjunct to relaxation training to address migraine. Instrumentation is used to monitor the physiologic effects of relaxation and/or to facilitate the learning of relaxation skills by providing visual and/or audio feedback about actual changes in otherwise invisible bodily processes. When described in this manner, it is evident that biofeedback itself is not a treatment modality. Rather, biofeedback instrumentation is used to enhance self-control and relaxation training. Therefore, in our biobehavioral approach to care, this technique is referred to as BART. Biofeedback instrumentation is used in the relaxation treatment process to accomplish three goals: (1) to make the child aware of physical responses, (2) to teach control of these responses, and (3) to transfer or generalize these skills to use in everyday life. "Biofeedback" is a form of complementary and alternative medicine (CAM) which involves measuring a subject's bodily processes such as blood pressure, heart rate, skin temperature, galvanic skin response (sweating), and muscle tension and conveying such information to him or her in real-time in order to raise his or her awareness and conscious control of the related physiological activities. By providing access to physiological information about which the user is generally unaware, biofeedback allows users to gain control over physical processes previously considered automatic. Research has demonstrated that biofeedback can help in the treatment of many diseases and painful conditions. It has shown that we have more control over so-called involuntary bodily function than we once though possible. But it has also shown that nature limits the extent of such control. Scientists are now trying to determine just how much voluntary control we can exert. Biofeedback can be used by coaches and educators to help people function better and by therapists as part

of treatment for many disorders including anxiety, urinary incontinence, fecal incontinence and constipation, migraine headaches, tension headaches, ADHD, ADD, pain from improperly functioning muscles in the jaws, shoulders, back, etc., irritable bowel syndrome, phobias, non-cardiac chest pain, high and low blood pressure, epilepsy, paralysis and other movement disorders, stress, and many other types of problems. Specialists who provide biofeedback training range from psychiatrists and psychologists to dentists, internists, nurses, physical therapists, and other mental health professionals. Most psychotherapists rely on many other techniques in addition to biofeedback. Patients usually are taught some form of relaxation exercise. Some learn to identify the circumstances that trigger their symptoms. They may also be taught how to avoid or cope with these stressful events. Most are encouraged to change their habits, and some are trained in special techniques for gaining such self-control. Biofeedback is not magic. It cannot cure disease or by itself make a person healthy. It is a tool, one of many available to health care professionals. It reminds physicians that behavior, thoughts, and feelings profoundly influence physical health. And it helps both patients and doctors understand that they must work together as a team. Patients' Responsibilities : Biofeedback places unusual demands on patients. They must examine their day-to-day lives to learn if they may be contributing to their own distress. They must recognize that they can, by their own efforts, remedy some physical ailments. They must commit themselves to practicing biofeedback or relaxation exercises every day. They must change bad habits, even ease up on some good ones. Most important, they must accept much of the responsibility for maintaining their own health. How Does Biofeedback Work ? Most patients who benefit from biofeedback are trained to relax and modify their behavior. Most scientists believe that relaxation is a key component in biofeedback treatment of many disorders, particularly those brought on or made worse by stress. Their reasoning is based on what is known about the effects of stress on the body. In brief, the argument goes like this: Stressful events produce strong emotions, which

arouse certain physical responses. Many of these responses are controlled by the sympathetic nervous system, the network of nerve tissues that helps prepare the body to meet emergencies by "flight or fight." The typical pattern of response to emergencies probably emerged during the time when all humans faced mostly physical threats. Although the "threats" we now live with are seldom physical, the body reacts as if they were: The pupils dilate to let in more light. Sweat pours out, reducing the chance of skin cuts. Blood vessels near the skin contract to reduce bleeding, while those in the brain and muscles dilate to increase the oxygen supply. The gastrointestinal tract, including the stomach and intestines, slows down to reduce the energy expensed in digestion. The heart beats faster, and blood pressure rises. Normally, people calm down when a stressful event is over especially if they have done something to cope with it. For instance, imagine your own reactions if you're walking down a dark street and hear someone running toward you. You get scared. Your body prepared you to ward off an attacker or run fast enough to get away. When you do escape, you gradually relax. If you get angry at your boss, it's a different matter. Your body may prepare to fight. But since you want to keep your job, you try to ignore the angry feelings. Similarly, if on the way home you get stalled in traffic, there's nothing you can do to get away. These situations can literally may you sick. Your body has prepared for action, but you cannot act. Individuals differ in the way they respond to stress. In some, one function, such as blood pressure, becomes more active while others remain normal. Many experts believe that these individual physical responses to stress can become habitual. When the body is repeatedly aroused, one or more functions may become permanently overactive. Actual damage to bodily tissues may eventually result. Biofeedback is often aimed at changing habitual reactions to stress that can cause pain or disease. Many clinicians believe that some of their patients and clients have forgotten how to relax. Feedback of physical responses such as skin temperature and muscle tension provides information to help patients recognize a relaxed state. The feedback signal may also act as a kind of reward for reducing tension.

What is biofeedback ?
Biofeedback is a treatment technique in which people are trained to improve their health by using signals from their own bodies. Physical therapists use biofeedback to help stroke victims regain movement in paralyzed muscles. Psychologists use it to help tense and anxious clients learn to relax. Specialists in many different fields use biofeedback to help their patients cope with pain. Chances are you have used biofeedback yourself. You've used it if you have ever taken your temperature or stepped on a scale. The thermometer tells you whether you're running a fever, the scale whether you've gained weight. Both devices "feed back" information about your body's condition. Armed with this information, you can take steps you've learned to improve the condition. When you're running a fever, you go to bed and drink plenty of fluids. When you've gained weight, you resolve to eat less and sometimes you do. Clinicians reply on complicated biofeedback machines in somewhat the same way that you rely on your scale or thermometer. Their machines can detect a person's internal bodily functions with far greater sensitivity and precision than a person can alone. This information may be valuable. Both patients and therapists use it to gauge and direct the progress of treatment. For patients, the biofeedback machine acts as a kind of sixth sense which allows them to "see" or "hear" activity inside their bodies. One commonly used type of machine, for example, picks up electrical signals in the muscles. It translates these signals into a form that patients can detect: It triggers a flashing light bulb, perhaps, or activates a beeper every time muscles grow more tense. If patients want to relax tense muscles, they try to slow down the flashing or beeping. Like a pitcher learning to throw a ball across a home plate, the biofeedback trainee, in an attempt to improve a skill, monitors the performance. When a pitch is off the mark, the ballplayer adjusts the delivery so that he performs better the next time he tries. When the light flashes or the beeper beeps too often, the biofeedback trainee makes internal adjustments which alter the signals. The biofeedback therapist

acts as a coach, standing at the sidelines setting goals and limits on what to expect and giving hints on how to improve performance.

The Beginnings of Biofeedback

The word "biofeedback" was coined in the late 1960s to describe laboratory procedures then being used to train experimental research subjects to alter brain activity, blood pressure, heart rate, and other bodily functions that normally are not controlled voluntarily. At the time, many scientists looked forward to the day when biofeedback would give us a major degree of control over our bodies. They thought, for instance, that we might be able to "will" ourselves to be more creative by changing the patterns of our brainwaves. Some believed that biofeedback would one day make it possible to do away with drug treatments that often cause uncomfortable side effects in patients with high blood pressure and other serious conditions. Today, most scientists agree that such high hopes were not realistic. Research has demonstrated that biofeedback can help in the treatment of many diseases and painful conditions. It has shown that we have more control over so-called involuntary bodily function than we once though possible. But it has also shown that nature limits the extent of such control. Scientists are now trying to determine just how much voluntary control we can exert.

How is Biofeedback Used Today?

Clinical biofeedback techniques that grew out of the early laboratory procedures are now widely used to treat an ever-lengthening list of conditions. These include:

Migraine headaches, tension headaches, and many other types of pain Disorders of the digestive system High blood pressure and its opposite, low blood pressure Cardiac arrhythmias (abnormalities, sometimes dangerous, in the rhythm of the heartbeat) Raynaud's disease (a circulatory disorder that causes uncomfortably cold hands) Epilepsy Paralysis and other movement disorders

Specialists who provide biofeedback training range from psychiatrists and psychologists to dentists, internists, nurses, and physical therapists. Most rely on many other techniques in addition to biofeedback. Patients usually are taught some form of relaxation exercise. Some learn to identify the circumstances that trigger their symptoms. They may also be taught how to avoid or cope with these stressful events. Most are encouraged to change their habits, and some are trained in special techniques for gaining such self-control. Biofeedback is not magic. It cannot cure disease or by itself make a person healthy. It is a tool, one of many available to health care professionals. It reminds physicians that behavior, thoughts, and feelings profoundly influence physical health. And it helps both patients and doctors understand that they must work together as a team.

The value of a feedback signal as information and reward may be even greater in the treatment of patients with paralyzed or spastic muscles. With these patients, biofeedback seems to be primarily a form of skill training like learning to pitch a ball. Instead of watching the ball, the patient watches the machine, which monitors activity in the affected muscle. Stroke victims with paralyzed arms and legs, for example, see that some part of their affected limbs remains active. The signal from the biofeedback machine proves it. This signal can guide the exercises that help patients regain use of their limbs. Perhaps just as important, the feedback convinces patients that the limbs are still alive. This reassurance often encourages them to continue their efforts.

Types of Biofeedback Instrumentation :

Electromyogram -- This is the most common form of biofeedback measurement. An EMG uses electrodes or other types of sensors to measure muscle tension. By the EMG alerting you to muscle tension, you can learn to recognize the feeling early on and try to control the tension right away. EMG is mainly used as a relaxation technique to help ease tension in those muscles involved in backaches, headaches, neck pain and grinding your teeth (bruxism). An EMG may be used to treat some illnesses in which the symptoms tend to worsen under stress, such as asthma and ulcers.

Peripheral Skin Temperature -- Sensors attached to your fingers or feet measure your skin temperature. Because body temperature often drops when a person experiences stress, a low reading can prompt you to begin relaxation techniques. Temperature biofeedback can help treat certain circulatory disorders, such as Raynaud's disease, or reduce the frequency of migraines. The physiological process behind the temperature drop associated with the stress response is quite simply vasoconstriction (blood vessels narrowed by the smooth musculature in their walls) Galvanic skin response training -- Sensors measure the activity of your sweat glands and the amount of perspiration on your skin, alerting you to anxiety. This information can be useful in treating emotional disorders such as phobias, anxiety and stuttering. This is the method most commonly used by a lie detector machine. Electroencephalogram -- An EEG monitors the activity of brain waves linked to different mental states, such as wakefulness, relaxation, calmness, light sleep and deep sleep. This is the least common of the methods, mostly due to the cost and availability of an EEG machine.

Origins of Biofeedback :
Neal Miller, a psychology Ph.D and neuroscientist who worked and studied at Yale University, is generally considered to be the father of modern-day biofeedback. He came across the basic principles of biofeedback when doing animal experimentation conditioning the behavior of rats. His team found that, by stimulating the pleasure centers of the rats' brains with electricity, it was possible to train rats to control phenomena ranging from their heart rates to their brainwaves. Until that point, it was believed that bodily processes like heart rate were under the control of the autonomic nervous system and not responsive to conscious effort.

Major modalities of Biofeedback Instrumentation

Electromyograph -An electromyograph, or EMG is the one of the most commonly used modalities in biofeedback treatment. An EMG in a biofeedback setting typically uses electrodes in order to measure muscle action potentials. These action potentials result in muscle tension. The patient can learn to recognize the way tension subjectively feels by using the objective EMG readings, and as a result learn to control the muscle tension. EMG is used as a relaxation technique to ease tension in the muscles causing backaches, neck pain, TMD, incontinence, and tension, migraine, and cluster headaches. EMG is also used in the process of muscle rehabilitation, such as in cases of paralysis resulting from Cerebral Palsy, stroke, and incomplete spinal cord lesions.

i) Feedback thermometer -Thermal Biofeedback This test measures skin temperature and can indicate problems with blood flow. Sensors attached to your fingers or feet measure your skin temperature. Stress leads to a fall in body temperature because arteries constrict causing blood flow to be limited to necessary organs and extremities. This reduced blood flow leads to problems like migraines and Raynauds disease (an ailment in which blood circulation can not reach fingers or toes). Using thermal biofeedback can help individuals recognize these symptoms and train their body to vasodilate. A thermistor attached to the subject's digits or web dorsum measures the subject's skin temperature. Because there is a correlation between a drop in body temperature and the patient's experience of stress, a low temperature reading indicates the need to begin relaxation techniques. Temperature biofeedback can also help in treating certain circulatory disorders, such as Raynaud's disease, and can reduce the frequency and severity of migraines. The physiological processes which are being trained in this modality are vasoconstriction and vasodialation, where blood vessel size is a result of the contraction and relaxation of smooth musculature in the vessel walls. The mechanism being trained in warming exercises is a beta-adrenergic vasodilator mechanism.

Skin Temperature What is it?

Skin Temperature is a measure of a person's state of relaxation. We have all touched someones hand that felt very cold. Some people always seem to have warm hands. Learning to increase your finger tip temperature is called Temperature training. This is one of the most basic techniques used in Biofeedback.

How do you do it? A Skin Temperature measuring instrument is used to continuously monitor the temperature. A small sensor is attached to a finger or toe using tape or a velcro band. If finger warming is being carried out the sensor can be lightly held between thumb and finger, when using this be aware that the reading can be increased for a short time by holding the sensor tighter but this can not be done for long. At the beginning the person is asked to think about warming their hand (or foot) getting warmer. Visualization helps, but the effective visualization varies from person to person. Examples are thinking of having your hands in front of a warm fire or in a warm muff. Within a short time the Temperature reading will start to change. This gives positive feedback that the person is doing the correct thing. Note this should be carried out in a warm room , 20deg C or 68 F for best results. Often when someone first tries this they try to hard and the reading will go down, then if they relax the reading will start to rise. With practice the amount of temperature rise will increase. Practice needs to be done for at least 20 min. a day an twice a day is better. It is useful to record the start and finish levels to get some idea of improvements over time. What is it used for? Temperature training is an effective way of learning relaxation and increasing the blood flow to the extremities. The Skin Temperature reading is an indication of autonmic response and can be used in psychotherapy for giving information on a persons resistance. Temperature training is a very good way of helping a person become more in tune with their body. In conditions involving chronic pain e.g. Rheumatoid arthritis, temperature training helps to reduce the pain and improve a person's general outlook. It

is used as an effective treatment for Raynaud's disease, high blood pressure, migraine headaches, OOS (RSI) and for general relaxation. What equipment do I need? The only equipment is a thermometer. An electronic model is best as it will allow changes of 0.1Deg to be seen. Being able to see small changes is important when starting out as initial changes may be small. It must also update the reading at least every 2 seconds. Beware that most low cost thermometers only update the reading every 10 seconds and this is too slow to be useful in Biofeedback. The sensor should not be to large as the larger the sensor the slower the response. Basic low cost temperature trainers typically only have a digital readout, but are a very useful basic tool and home trainer. More advanced instruments measure Skin Temperature and display it as a sound and bargraph. Computer systems often have a selection of displays

ii) Electroencephalograph
An electroencephalograph, or EEG monitors the activity of brain waves. These brain waves correspond to different mental states, such as wakefulness (Beta waves), relaxation (Alpha waves), calmness (Theta waves), and light sleep and deep sleep (Delta waves). EEGs are useful in the treatment of anxiety and ADHD. An EEG monitors the activity of brain waves linked to different and deep mental states, such as wakefulness, relaxation, calmness, light sleep and deep sleep. The brain emits electrical signals of various frequencies. Only a few of these waves can be tied to specific disorders or mental states. The following are classification of brain waves: Alpha, Beta ,Theta, and Delta waves. This is the least common of the methods, mostly due to the cost and availability of an EEG machine.

Biofeedback Useful for Epilepsy

Biofeedback, short form for biological feedback, is basically the monitoring of internal body states. Watching and listening to sensitive instruments that mirror psychophysiological processes helps you understand body processes which you are not normally aware of.

An electronic instrument detects, amplifies, and then gives you immediate information (feedback) about your own conditions, such as: brain wave activity (EEG or electroencephalograph). This feedback guides you as you become more in touch with your mind and body. This aspect of Biofeedback is very useful in case of Epilepsy. This is because people with epilepsy have brains that continuously misfire (not just during seizures). This is one way neurologists make a diagnosis. This continuous misfiring often involves only a few brain cells, no bigger than the point of a pin. When brain cells surrounding the misfiring or damaged cells are activated, a seizure may occur. There were several researches conducted to demonstrate the relevance of biofeedback for epilepsy.Since the 1970s researchers have demonstrated in over 50 controlled studies that a special form of brain wave biofeedback - now called neurofeedback safely and effectively trains the brain to stabilize its activity. The treatment has been used successfully with all types of seizure disorders. Often the effects are permanent. In training sessions, computerized biofeedback instrumentation detects and displays the brain waves on a computer screen. The program allows for simultaneous inhibition of slow wave EEG (the brain wave activity associated with seizure disorders) while reinforcing mid-range frequencies associated with preventing seizures. Much of the learning takes place simply with practice while receiving positive reinforcement from the computer. After enough training sessions the aura rate goes down and so does the seizure rate. No one knows exactly what occurs as we learn to normalize the brain wave activity (produce EEG patterns which dont trigger seizures), but it works. Patients who have seizures triggered by anxiety or stressful situations may benefit from this therapy, in addition to their seizure medications.

iii) Photoplethysmograph
Photoplethysmographs, or PPGs, in biofeedback are used to measure peripheral blood flow, heart rate, and heart rate variability(HRV). To measure HRV, PPGs measure the varying distances between heart beats, also known as the interbeat interval (IBI). This data guides users in finding a breathing pattern that increases their variability. PPGs are also helpful in biofeedback treatment for some types of cardiac arrhythmias.

Heart rate variability

Heart rate variability (HRV) is a measure of the beat-to-beat variations in heart rate. It is usually calculated by analyzing a time series of beat-to-beat intervals from the ECG, of beat-to-beat intervals derived from an arterial pressure tracing or of beat-to-beat intervals derived from a pulse wave signal measured by means of a photoplethysmograph (PPG). Various measures of heart rate variability have been proposed, which can roughly be subdivided into time domain, frequency domain and geometric measures. HRV is regarded as an indicator of the activity of autonomic regulation of circulatory function, although controversy exists over whether this is an accurate metric for analyzing cardiovascular autonomic control. Alterations (mostly reductions) in HRV have been reported to be associated with various pathologic conditions such as hypertension, hemorrhagic shock, and septic shock. It also has some utility as a modest predictor of mortality after an acute myocardial infarction. Time domain measures A simple example of a time domain measure is the calculation of the standard deviation of beat-to-beat intervals. In other words the time intervals between heart beats can be statistically analyzed to obtain information about the autonomic nervous system. Other time domain measures include root mean square of the differences between heart beats (rMSSD), NN50 or the number of normal to normal complexes that fall within 50 milliseconds, and pNN50 or the percentage of total number beats that fall with 50 milliseconds. Frequency domain measures

A common frequency domain method is the application of the discrete Fourier transform to the beat-to-beat interval time series. This provides an estimation of the amount of variation at specific frequencies. Several frequency bands of interest have been defined in humans.

High Frequency band (HF) between 0.15 and 0.4 Hz. HF is driven by respiration and appears to derive mainly from vagal activity or the parasympathetic nervous system.

Low Frequency band (LF) between 0.04 and 0.15 Hz. LF derives from both parasympathetic and sympathetic activity and has been hypothesized to reflect the delay in the baroreceptor loop.

Very Low Frequency band (VLF) band between 0.0033 and 0.04 Hz. The origin of VLF is not well known, but it had been attributed to thermal regulation of the body's internal systems.

Ultra Low Frequency (ULF) band between 0 and 0.0033 Hz. The major background of ULF is day/night variation and therefore is only expressed in 24hour recordings.

The ratio of low-to-high frequency spectra power (LF/HF) is used as an index of sympathetic to parasympathetic balance of heart rate fluctuation, but this remains controversial because of still little understanding of the LF component, which may be affected by centrally generated brainstem rhythms, baro-reflex influences, as well as both sympathetic and parasympathetic inputs, etc.

Geometric measures The most commonly used non-linear method of analyzing heart rate variability is the Poincar plot. The Poincar plot fits heart rate data points to an ellipse that is fitted to two intersecting lines. SD1 and SD2, or the standard deviations of the data points have also been applied in the context of Poincar analysis.

iv) Pneumograph
A pneumograph measures abdominal/chest movement (as when breathing), usually with a strain gauge. They are used to detect breathing rate, and correct ineffective breathing

patterns such as thoracic breathing, reverse breathing, and apnea. They are also often used in conjunction with a PPG in HRV training.

v) Capnometer
A capnometer measures end-tidal CO2 with an infrared detector. All biofeedback training that employs the use of a capnometer aims at normalizing end-tidal CO2 at 5%. Capnometric biofeedback is useful in the treatment of hyperventilation syndrome. During hyperventilation, end-tidal CO2 lowers from a normal level of 5% to 2.5%. Respiration Feedback This test measures breathing rate and allows patients to learn to control conditions such as anxiety, asthma, and hyperventilation.

vi) Hemoencephalography
Hemoencephalography, or HEG biofeedback is a method of functional infrared imaging that indirectly measures neural activity in the brain. There are two known types of HEG, passive infrared (pIR) and near infrared (nIR).Near infrared HEG measures the differences in color of light reflected back through the scalp, based on the relative amount of oxygenated and unoxygenated blood in the brain. Passive infrared measures the amount of heat that is radiated by the scalp at various locations of interest. Hemoencephalography (HEG) is a type of functional near-infrared imaging (fNIR) of the level of neuronal activity in the brain. One method of doing this takes advantage of the translucent nature of the cranium and differences in absorption rates of various wavelengths of light for oxygenated vs. unoxygenated blood. Two different lights placed on the scalp are shone into the brain and the relative differences between the amount of each light that is reflected back out through the scalp provide a relative measure of changes in blood oxygen level. Another method simply involves placing an infrared sensor on the scalp to detect the amount of heat radiation at that spot. Although each method detects changes in level of cerebral activity, one as it as reflected in oxygen level, the other as reflected by thermal level, and although each method is used for similar biofeedback purposes, e.g. treatment of migraine headaches, the pattern of results are somewhat different at times.

vii) Electrodermograph
In electrodermograph training, sensors measure the activity of a patient's sweat glands. The amount of electrical resistance measured on the skin indicates the level of anxiety. This information can then be used to treat emotional disorders such as phobias, anxiety and stuttering. The best-known use of this method of biofeedback is in polygraph machines. Galvanic skin response meters are currently gaining popularity in hypnotherapy and psychotherapy practices, so subtle physiological changes that indicate emotional arousal can be more easily detected. Galvanic skin Response Training This technique is similar to that of a Lie Detecting Machine. The activity of your sweat glands and amount of perspiration on your skin is measured by the sensors, thus alerting you to anxiety. This knowledge is useful in treating emotional disorders like stuttering, phobias and anxiety. Galvanic skin response Galvanic skin response (GSR), also known as electrodermal response (EDR), psychogalvanic reflex (PGR), or skin conductance response (SCR), is a method of measuring the electrical resistance of the skin. There has been a long history of electrodermal activity research, most of it dealing with spontaneous fluctuations. Most investigators accept the phenomenon without understanding exactly what it means. There is a relationship between sympathetic activity and emotional arousal, although one cannot identify the specific emotion being elicited. The GSR is highly sensitive to emotions in some people. Fear, anger, startle response, orienting response and sexual feelings are all among the emotions which may produce similar GSR responses. Practice GSR is conducted by attaching two leads to the skin, and acquiring a base measure. Then, as the activity being studied is performed, recordings are made from the leads. There are two ways to perform a GSR - in active GSR, current is passed through the body, with the resistance measured. In passive GSR, current generated by the body itself is measured.

Uses GSR measurement is one component of polygraph devices and is used in scientific research of emotional arousal.GSR measurement is also becoming commonplace in hypnotherapy and psychotherapy practice where it can be used as a method of detecting depth of hypnotic trance prior to suggestion therapy commencing. When traumatic material is experienced by the client (for example, during hypnoanalysis), immediate changes in galvanic skin response can indicate that the client is experiencing emotional arousal. It is also used in behavior therapy to measure physiological reactions such as fear. Skin conductance is also a factor in some modern electronics to measure the activation of touchscreen devices. This is notable as many of these devices that use capacitive screens cannot be used while wearing gloves as the sensors are not triggered by the low conductivity of rubber or leather. Skin Conductance (GSR) biofeedback instruments are the first step in bringing hypnosis from the nether regions of the occult into the domain of science. The use of these instruments provides an empirical basis for hypnosis, transforming it from a personal art to an objective science. In the past hypnosis has been a much misunderstood and frequently suspect technique of therapeutic treatment. Stage hypnotists, using highly responsive subjects and a vaudeville showmanship approach have given the field an undeserved aura of mystery and chicanery. Meanehile legitimate practitioners have sometimes achieved miracle cures which have defied scientific explanation. Since the hypnotic process has never been substantiated through scientific invertigation, the technique has remained controversial. Some professionals and laymen are enthusiastic, if not fanatical, about its value while others have flatly rejected it. With the use of Skin Conductance biofeedback instrumentation some aspects of the hypnotic process can be made scientifically objective thereby increasing the general credibility of the process. Primary values of Skin Conductance biofeedback instruments are: 1. Helping clients to reach deeper levels of relaxation

2. Providing hypnotists with objective indications of relaxation depth 3. Demonstrating the efficacy of a characteristic induction process with a particular client 4. Indicating whether or not suggestions given are acceptable to the client. Secondary values are : 1. Sharing responsibility with the client for entering a state of hypnosis. 2. Increasing the confidence of the client in the hypnotist and the hypnotic process. 3. Establishing a professional image of the hypnotist. 4. Improving the training and expertise of hypnotists. Traditional hypnosis consists of three phases; the induction, the reprogramming suggestions, and the return. The purpose of the induction is to quiet the body, mind and emotions of the subject so that in the second phase full attention is brought to focus on the issue of concern. When the person is quiescent, suggestions are apt to have the greatest impact. Given a successful induction, the suggestions or affirmations work best when: 1. the critical faculty of the client is absent 2. the client focuses on one belief, attitude, or idea 3. the client can clearly visualize a new situation, habit pattern, skill or whatever is relevant. While these conditions are neither necessary nor sufficient for successfully reprogramming the mind, most hypnotists work towards establishing them during the hypnotic process. Moreover, these are general conditions useful for nearly any learning activity, and hypnosis usually involves some learning on the part of the subject. In the initial phase hypnosis has some similarity to mediation techniques. Hypnotists sek to quiet the body and mind before implanting suggestion. Mediators also begin by quieting the body and mind. In a sense, hypnosis could be called " applied meditation". One difference between meditation and hypnosis is that hypnosis often deals with the notion of a subconscious mind while meditation aims to contact a superconscious mind.

With instrumentation and feedback, both client and hypnotist are aware of what is happening and both can work together to lower the client's stress level. It is not a question of the "will" of the hypnotist against the "will" of the client, both cooperate. The client takes responsibility for their own condition; they do not surrender their will to the hypnotist. This helps to bypass the issue of trust and the whole process goes smoother and more efficiently. By taking inexpensive biofeedback instruments home, clients can practice more effectively, with greater interest, and with objective indications of their success. The client can learn to relax more rapidly and more deeply. The hynotist can learn which induction method works best for that person and can tell when they are deeply relaxed. There is no need to test for depth by challenges- the hypnotist can simply look at the meter or note the pitch of the sound. This leaves him free to concentrate on preparing and administering hypnotic prescription or otherwise working with the client while they are in a deeply relaxed state. Sometimes the hypnotist may not wish to have the tone of the instrument audible. It may disturb the client or interfere with tape recording. A Skin Conductance instrument which has a meter has a control to turn off the sound. When the subjecthas successfully dropped the pitch or lowered the meter needle, the operator can reset the controls to a higher level again and request the subject to go even deeper into relaxation. This deepening process can be repeated several times during the course of a typical induction. When the client is sufficiently relaxed the next phase of the process can begin. During the induction my associates and I suggest that the person let their body go to sleep, while their conscious mind remain aware and alert. This seems to be a more accurate way of stating what happens. Of course the subject does not go into any kind of trance state. Typically they experience a sensation of floating within the body. We use the term "nexus" to talk with them about that condition. In nexus, which denotes a tie or link, the subject can either connect to his subconscious body-mind or his superconscious mind. Nexus is not an all or none state, rather it is more like a progressive condition. From the point of power which we call nexus, a person can direct their subconscious or ask for guidance from their superconscious. Complete programs work with all three minds and in this sense hypnosis ought to be considered as a state of greater wakefulness rather than sleep.

When a person is in the nexus condition the skin conductance will continue to reflect changes. Sometimes the slightest thought, worry, or distraction will produce a skin conductance reaction. If the hypnotist gives a suggestion which is not acceptable to the subject the skin conductance will often indicate this by a pitch increase. Any comment by the hypnotist which has any emotional charge will be indicated as a skin conductance change and the hypnotist can either explore the matter immediately or note it and ask the subject about it after the session. In reprogramming the subconscious mind via the conscious mind, we ask the subject to visualize what he or she wants to happen. Visualization has been found to help imprint the new program. With biofeedback, both subject and hypnotist have an indication of the clarity of the visualization, and a means of training for improvement. Skin Conductance Monitor Stress - The final frontier Uncontrolled stress prevents you from reaching your full potential. Headaches, phobias, hypertension, obesity, sleeplessness, chronic pain, smoking another conditions are all linked to and aggravated by chronic stress.

Stress is a part of everyday life, and it keeps many people from functioning at their optimum level because they do not know how stressed they are or how to control it. Biofeedback is a widely used and medically accepted technique for teaching control of stress. Relaxation releases energy, allowing the energy being wasted on stress to be

channeled into more productive activity. Learn to control your stress, in your own home, using Biofeedback. The proven most effective way to control stress and learn true relaxation. Feel better, sleep better, helps to achieve your personal goals. The Biofeed Skin Conductance monitor measures your body's reaction to emotional and physical stress with great sensitivity, and gives 'feedback' on changes from moment to moment in your tension level by means of a tone and meter reading. It lets you monitor and control your stress by amplifying tiny stress related changes in y or skin into a sound and movement on the built in meter. Simply wrap the two sensors around your finger tips and you will see and hear how different events affect your stress level. Just thinking about something stressful will cause a change. As your stress increases so does the tone and the meter needle moves up the scale. There are various techniques of Biofeedback that are used by Therapists and Practitioners so as to bring about relief to patients. These techniques help the patient to identify Psychophysical symptoms and gain control over physical processes previously considered automatic.

viii) Electromyogram (EMG)

This is the most common form of biofeedback measurement. An EMG uses electrodes or other types of sensors to measure muscle tension. The most common muscles that biofeedback practitioners will use are the frontalis (the frowning muscle in your forehead), the masseter (jaw muscle), and the trapezium (the shoulder muscles that hunch when youre stressed). When the electrodes pick up on muscle tension, the machine gives you a signal, such as a colored light or sound. When the EMG alerts you to muscle tension, you can learn to recognize and control the tension right away. It helps ease tension in those muscles involved in backaches, headaches, neck pain and grinding your teeth (bruxism). It is also useful for treating stress related illnesses such as asthma and ulcers. Electromyography (EMG)

This test helps individuals recognize symptoms before and during muscle tension, injury, and pain. The sensors help measure the activity of the nerves that manage muscles.

Types of biofeedback and their uses

Biofeedback works by using electronic instrumentation to monitor specific physiological activities-often unconscious-and habits of your body and then feeds it back to you. With this information, you can change those patterns of behaviour or eliminate them completely. It is helpful in curing chronic, benign problems because it lowers the use of drugs and visits to the doctor. Some of the equipment it uses are: Electromyogram (EMG): This equipment uses electrodes or other kinds of sensors to measure muscle tension. Once you are alerted to muscle tension, you can begin to recognize your own feelings early on and try to control the tension. With EMG, you can learn to relax your muscles that bring on backaches, headaches, neck pain and bruxism or grinding of teeth, apart from asthma and ulcers. Temperature biofeedback: With sensors attached to your fingers or feet, you can measure your skin temperature. When your temperature falls at stressful times, a low reading can make you begin relaxation techniques. Besides, biofeedback can also help treat Raynauds disease and reduce the frequency of migraines. Galvanic skin response training: With the help of sensors, you can also measure the activity of your sweat glands and the amount of sweat on your skin, which can alert you to become anxious. With this information, you can treat emotional disorders such as phobias, anxiety and stuttering. Electroencephalogram (EEG): The activity of the brain waves linked to different mental states, such as wakefulness, relaxation, calmness, light sleep and deep sleep, can be measured by an EEG.

Biofeedback can also be helpful in these conditions:

It can reduce or negate the need for medication. It can help in those conditions where medication hasnt. By providing measurable feedback, it allows you to be in charge of your own healing and monitoring your own progress. It can decrease your medical costs.