Medical University – Pleven

Physiology course for students of “Medicine” –

#2 practical class
“Biofeedback”

Introduction

We are all familiar with the physiological activity associated with stress, such as sweaty
palms, increased heart rate, and increased respiratory rate. This physiological activity
related to stress was initially considered to be an automatic process, outside our
conscious control. However, it has been known for many years that we can have
substantial control over such unconscious bodily processes, if we are provided with a
better means of perceiving our own body’s functioning. Biofeedback involves the use of
measurement and display of information about physiological processes, of which the
volunteer is usually unaware. By providing a physiological mirror to your own body
processes, biofeedback allows you to learn techniques to control the biological functions
underlying the stressed state. The volunteer then uses this information to control the
body processes.
History

The term biofeedback was coined at a conference in 1969. However, biofeedback dates
back further, with the invention of the perineometer by Arnold Kegel in 1947. The
perineometer was used to treat urinary incontinence in women following childbirth. The
perineometer monitored the strength of pelvic floor muscle contraction to enhance the
effectiveness of Kegel exercises, designed to strengthen pelvic floor muscles. More
recently, biofeedback training has been used by sports teams including the Boston
Celtics and AC Milan where athletes can learn how to control their physiological
responses to stress so that they can perform precision tasks whilst under considerable
pressure.
Feedback

In a physiological negative feedback system a controlled variable has a set

point around which it is controlled. Sensors determine the actual value of the controlled
variable, and feed this information to the integration center. The integration center
compares the set point value to the actual value, and if they are not equal it stimulates
effectors to reduce this discrepancy. This process happens continuously, and so the
controlled variable is maintained around its set point value.
In a biofeedback system, the volunteer is trying to control a biological variable in a
direction that is determined by the volunteer or the experimenter. The value of the
biological variable is measured and this information is fed back to the volunteer in some
way (usually via visual or audio feedback). The volunteer then makes behavioral
changes (feedforward control). If the behavioral changes have the desired effect on the
biological variable, the feedback will inform the volunteer of this success and they will
then continue with the behavioral change.
Types of measurements

Some of the measurements that may be used for biofeedback include the following:

 Electrodermal response (EDR; also known as the galvanic skin response (GSR)
or skin conductance)
 Skin temperature

 Electrocardiography

 Electromyography

 Electroencephalography

 Photoplethysmography

 Blood pressure

 Respiratory rate

 Heart rate variability

All of these signals are able to be influenced, at

least to some degree, by conscious control.

Heart rate

Heart rate is determined by the pacemaker

activity of the sinoatrial (SA) node. The intrinsic
firing rate of the SA node is around 100 beats
per minute. Heart rate is increased by a
withdrawal of parasympathetic activity and an
increase in sympathetic activity. Heart rate is decreased by a decrease in sympathetic
activity and an increase in parasympathetic activity. At rest, there is both sympathetic
and parasympathetic input.

The electrical activity of the heart can be measured by recording electrodes on the skin
surface, which allows the recording of an electrocardiogram (ECG). The electrical
activity that is detected is amplified and filtered. There is a regular pattern of peaks that
occur with every cardiac cycle. From these peaks, the heart rate can be determined.

Heart rate biofeedback is commonly used in fitness training with the use of heart rate
monitors to help keep exercise at a desired intensity. Heart rate biofeedback can also
be used to learn self-calming techniques.

EDR

The EDR is also known as the GSR. To assess the EDR, the electrical conductance
between two points on the skin is measured. A GSR amplifier briefly applies a small
constant current between two electrodes (usually placed on the fingers), and measures
the voltage that arises as current flows through the resistance offered by the skin.
Changes in resistance (such as those brought about by sweating) change the voltage
that is measured. It is conventional to talk about skin conductance (the reciprocal of
resistance), which expresses the ease with which current flows through the skin. Skin
conductance is measured in microsiemens (μS).

Eccrine sweat glands are the major sweat glands of the body. They are present on
almost every body surface. Sweat production by the eccrine sweat glands is stimulated
by sympathetic nervous activity, primarily for thermoregulation. However, sweat
production by the eccrine sweat glands on the palms of the hands, and the soles of the
feet, is also induced by emotional stressors.

Electrodermal activity has been of interest as a psychophysiological measure since the

early 20th century, when it was used by the psychiatrist Carl Jung. When a volunteer is
calm and relaxed, the skin is dry and the conductance low. During sympathetic nervous
system arousal of a volunteer under stressful conditions, sweat is secreted, and its salt
content increases the skin’s conductance.
The startle response is elicited by an intense stimulus with a sudden onset. It involves
both somatic and cardiorespiratory components, and results in an increase in skin
conductance, an immediate increase in heart rate, and an alteration in breathing.

Skin temperature

While core body temperature is regulated within a relatively narrow range from about
36–37.3°C (97.3–99.1°F), skin temperature is not regulated. In the absence of sweating
or shivering, the temperature of the skin depends largely on blood flow to the skin.
When the core body temperature is elevated, the arterioles supplying the skin
vasodilate, which increases blood flow to the skin and therefore heat loss via convection
and conduction. When the core body temperature is decreased, the arterioles supplying
the skin vasoconstrict, which deceases blood flow to the skin.
Skin temperature can be measured using a thermistor. Thermistors are temperature
sensitive electrical resistors. As temperature increases, they conduct electricity more
readily. A simple circuit inside the thermometer measures the electrical resistance of the
thermistor and converts this to a temperature that is displayed on the thermometer.

Skin blood flow is under control of the sympathetic nervous system. Sympathetic
nervous system activity causes vasoconstriction of the arterioles supplying blood to the
skin, decreasing the skin temperature. Therefore, by removing stress you may be able
to reduce the amount of sympathetic nervous activity, thus increasing blood flow to the
skin and increasing skin temperature. Biofeedback therapy uses control of skin
temperature as a way of monitoring relaxation. So, as a person becomes more relaxed,
their skin temperature will increase. By providing information about a volunteer's skin
temperature and how it changes as they try to relax, the efficacy of relaxation
techniques can be assessed.
Use of biofeedback as a therapy

Biofeedback therapy aims to allow the patient to voluntarily control physiological activity
that is normally involuntary, or has become involuntary through trauma or disease. The
efficacy of biofeedback therapy is somewhat controversial. However, according to the
American Psychological Association, biofeedback therapy has been shown to improve
headaches (migraine and tension), incontinence, attention deficit disorder (ADD), and
attention deficit hyperactivity disorder (ADHD).