The doctor in your mind

Biofeedback training can help control the body’s ‘autonomic’ functions to reduce the need for medication.

By JUDY SIEGEL-ITZKOVICH
PROF. FRANK ANDRASIK (left) and Dr. David Wilensky (photo credit: Judy Siegel-Itzkovich)
PROF. FRANK ANDRASIK (left) and Dr. David Wilensky
(photo credit: Judy Siegel-Itzkovich)
It was long believed that people can consciously control their emotions and thoughts, but have no power to influence their autonomic nervous system, such as their heart and respiration rates, skin conductance, muscle tone, pain perception and brainwaves.
But since the late 1960s, medicine has come around to acknowledging the fact that individuals can manipulate even these functions at will by becoming aware of them using a variety of instruments. Thus people can be trained to alter their blood pressure (either lower or raise it), head off migraines and control other bodily functions that normally are not influenced voluntarily. This means they can alleviate medical conditions and improve their health by using signals from their own bodies.
In 1969, this treatment approach was formally named “biofeedback” at the Conference on Altered States of Consciousness in Kansas, and the first meeting of the Biofeedback Research Society in Santa Monica, California.
BUT ALTHOUGH more than four decades have passed, biofeedback has not gotten very far in daily practice. There are three main reasons for this: Biofeedback devices don’t generate the huge income of the pharmaceutical industry, which finances the bulk of biomedical research and has a very powerful lobby. Advocates initially exaggerated the potential health benefits of biofeedback, and predicted it would give people significant control over their bodies, eliminating the need for many medications. As a result of such wholesale claims, which turned off some doctors, many biofeedback treatments have not been systematically studied or recognized.
As a result, biofeedback is still regarded by numerous health systems, including those in Israel and the US, as “complementary medicine” and is thus not covered by health insurance; they are not, for example, included in Israel’s basket of health services. Yet today’s patients tend to prefer a non-drug approach because they suffer side effects from medication or cannot take them at all because they are contraindicated by existing conditions, or because women are pregnant or breastfeeding.
A leading biofeedback researcher from the US, who recently made his first visit to Israel, may try to change this, and with collaboration with local advocates, promotes the study and use of biofeedback here as well. Prof. Frank Andrasik, now head of the psychology department at the University of Memphis in Tennessee, has devoted much of his professional life to the study of biofeedback.
A past president of the American Biofeedback Association and the outgoing president of the Cognitive- Behavioral Psychology Association, Andrasik was recently hosted in Israel by Jerusalem pediatrician and child psychiatrist Dr. David Wilensky, chairman of the Israel Biofeedback Association. Andrasik had not even met Wilensky before arriving; his first Israeli connection was Dr. Arnon Rolnick – an Israeli neuroscientist and clinical psychologist who attended a biofeedback lecture with Andrasik and has been active in the Israel Association for Applied Psychophysiology and Biofeedback Association. Wilensky organized a number of appearances and lectures for his guest, including at Sheba Medical Center at Tel Hashomer, the Tel Aviv-Jaffa Academic College and a headache conference for neurologists at a Tel Aviv hotel. Both Andrasik and Wilensky gave an interview to The Jerusalem Post.
BEFORE 2010, when Andrasik joined the Tennessee university of some 23,000 students, he was a distinguished professor of psychology at the University of West Florida in Pensacola and a senior research scientist at the Florida Institute for Human & Machine Cognition. At both institutions, his research focused on clinical health psychology, focusing mainly on pain, stress and applied psychophysiology, including biofeedback. The move of the Ohio-born clinical psychologist from Florida after 23 years to Memphis involved more training of physicians, as the University of West Florida had few such programs.
“The chance to help move a prestigious unit forward and be a part of something much bigger than oneself appealed to me,” he said.
Andrasik is a Fellow in the American Psychological Association, the Society of Behavioral Medicine and the Association for Psychological Science. He has published several hundred articles in professional journals, and edited chapters in texts. His new department has 33 faculty members, 10 additional staffers, 900 undergraduates plus 150 graduates and postgraduate students.
“I started out with the intention of becoming an engineer in Michigan. I liked mathematics, physics and other sciences, but after a year I saw I didn’t like the idea of engineering or of being a math teacher as I had thought.” When he took psychology as an elective subject, one professor invited him to work in his lab. “ I was hooked on psychology, although it took a while to decide what brand of psychology I choose.”
Andrasik told The Post that he was the first in his family of two brothers and four sisters to go to college, except one who went into teaching. “My father ran a small neighborhood grocery, so I had no role models and didn’t get a lot of advice. But the University of Ohio offered me the best scholarship, so the school literally picked me.”
His wife Candace (Candy) does have a medical background, however, as she is a registered nurse.
He learned about biofeedback at the University of Ohio’s graduate school in the 1970s. “I was always interested in the mind-body connection,” he explained. “I wanted to know more about how they influence each other. We in biofeedback research wanted to give patients choices. Many are not helped by drugs. No medication works for everybody.”
INITIALLY, MUCH of his biofeedback work was on lab animals, but later he proceeded to people. “There was a controversy whether people can really learn to control physiological functions. Nobody was ready to believe that brainwaves can be controlled. It takes many practice sessions, but it can be done.” Today, computers and even vehicles have been controlled experimentally after short training sessions while wearing a flexible helmet and merely thinking.
He was pleased to note that the Israeli-invented biofeedback device named RESPeRATE to lower blood pressure has been approved by the US Food and Drug Administration. “It is widely advertised in US newspapers,” he said. “It is relatively inexpensive, and users can train themselves with music to slow their respiration rate, lowering their essential blood pressure.”
Andrasik added that even a few sessions a week have been shown to affect breathing rates the rest of the time and lower blood pressure, eliminating or reducing the need to take hypertension medication.
The technology is based on understanding the body’s “flight or fight” response to danger and stress, and relaxation is a major part of biofeedback treatment for many disorders – especially those triggered or worsened by stress, which stimulates physical responses. Fight-or-flight probably originated in ancient man’s primitive response to physical threats from wild animals, physical disaster or human enemies. The potential victim begins to sweat; his heart speeds up; pupils dilate to allow more light in; blood pressure rises as the heart works harder; and the stomach and intestines slow down so as not to waste energy on processing food. Although modern man is not usually threatened by such attackers, most individuals suffer from stressrelated symptoms on a very frequent basis.
Andrasik says that while he does not personally use RESPeRATE, he has learned to get his breathing down to six times a minute to relax. “I learned on my own; it becomes automatic.” But he has received from the Israeli company a number of units that he plans to try on African Americans in his area in Memphis. “They have more hypertension and higher morbidity, so I want to see whether they can be helped to lower their blood pressure like that in Caucasians.” RESPeRATE is based on the pneumograph, in which the user wears a flexible sensor band between the chest and the abdomen to measure the number of breaths per minute.
Muscle tone is tested by the electromyograph, with electrodes placed over one muscle at a time.
Thi is used to treat chronic pain, migraine and other headaches, lower-back pain, temporomandibular (jaw) joint disorder and fecal and urinary incontinence.
Other tools for biofeedback include the electrodermograph (that monitors skin conductance and potential) for trying to treat excessive sweating and a variety of anxiety disorders; electroencephalograph (EEG) for electrical activity of the brain via the scalp for attention-deficit hyperactivity disorder (ADHD), depression and migraine; the photoplethysmograph to monitor blood flow via bands on the fingers or forehead for treating chronic pain, headache and other conditions; the electrocardiograph (ECG) to check heartbeat; and the rheoencephalograph (REG), following blood flow with electrodes on the head.
In 2008, the Association for Applied Psychophysiology recognized five levels of efficacy for gauging benefits from biofeedback. Level 1 means that an application was not empirically supported but based only on anecdotal reports or non-peer-reviewed studies.
These include using biofeedback to treat eating disorders, immune function and spinal cord injury.
Level 2 means it may possibly be efficacious but needs more proof. Under this category are asthma, autism, Bell’s palsy, cerebral palsy, chronic obstructive pulmonary disease, depression, irritable bowel syndrome, post-traumatic stress disorder and tinnitus.
Level 3 means biofeedback is “probably efficacious” but requires clinical and replication studies. Level 4 means that a treatment has been proven efficacious in randomized studies with a control group or placebo control and other criteria. Level 5 is the highest, showing efficacy, specificity and statistical superiority to placebos in at least two independent research settings.
Wilensky noted that he knows of mental health clinics like his that use biofeedback to treat numerous problems; a just-published Tel Aviv study examined stress reactions of children to missile attacks in the south, and found biofeedback offers relief.
Among the cases of people who have responded well to biofeedback are a child with a type of autism and attention problems who, after neurofeedback, improved so much that he was able to serve in the military; a woman with chronic fatigue syndrome who is now free of symptoms; and a teenaged girl with generalized anxiety who was subsequently able to sleep over with friends and go on a class trip.
“We, in our organization of 1,000 professionals who use biofeedback, have strict guidelines, but it is not supervised by the Health Ministry. Anybody can buy a machine and open an office,” Wilensky frowned.
Now that Andrasik has come to Israel, Wilensky is eager for him and his Israeli colleagues to collaborate with his guest on research, and perhaps write review articles on biofeedback in Israeli and American journals.
In another decade, the Tennessee researcher believes there will be more affordable and effective biofeedback devices. “We will be able to monitor physiology on an ordinary laptop computer. There will be more medical recognition and functions that people can train on and use themselves, like RESPeRATE.”
Cognitive behavior, pain, stress and other problems will be treated with it, he said.
Wilensky has heard of an Israeli application being prepared for the i-Phone, in which the device can measure pulse and give the user feedback on the screen. “The economics of healthcare is an international issue. If one can prevent or ease health problems, saving money, biofeedback will be regarded as very beneficial, and it could also reduce disparities in medical care between the wealthy and others.”