Biofeedback is becoming increasingly important in modern psychotherapy. This innovative method enables therapists and patients to monitor and interpret physiological data in real time. But how exactly can biofeedback really enhance psychotherapeutic treatment in practice? In an exclusive interview, we spoke to the experienced psychotherapist Dr Ellena Huse about this: 
Question: In your opinion, how effective would you rate biofeedback as a complementary approach in psychotherapeutic treatment, and where do you see the added value of integrating it into psychotherapy?
Answer: I see particular added value in the fact that we have direct access to physiological data. We can see and visualise what is happening inside the body. This is a major advantage, particularly for patients with anxiety, who often have a strong fixation on bodily processes, such as those with panic disorder or cardiac neurosis. These patients are intensely preoccupied with their bodily processes. In traditional psychotherapy, where the body is often not taken into account, it is difficult to convince patients that physical symptoms are not dangerous. The added value of biofeedback lies in the fact that we can incorporate the body into the process. If you say to an anxiety patient: „Right, let’s first have a look at what your body is actually doing“ – and then do exactly that, namely recording bodily processes, examining them together and interpreting them together – this adds significant value to the therapeutic relationship. Patients feel they are being taken much more seriously than if they were simply being pressured by the doctor end up on this „psychological track“, where at first they sometimes don’t even recognise themselves. It’s often a very good way to get them started in therapy.
Question: Modern biofeedback systems offer many ways to provide feedback on physical parameters. Which parameters have you found most useful, and what have you found to be particularly effective with your clients?
Answer: First of all, I think it’s important to look at which parameters actually react and how. Often, you have a certain idea; for example, when a patient says: „My heart beats so strongly then, and I get this fear that it might be a heart attack. “My father also died of a heart attack and I know I have a genetic predisposition to it. I can feel my heart beating like that too. There must be something wrong.’ In that case, it would be natural to say that I’ll work with the pulse rate. That usually works well.
However, even if I have several parameters, I still think it’s important to measure all of them. In my opinion, a good biofeedback treatment always begins with what is known as a ‘stress provocation’, during which different states and parameters are compared. If a patient reports problems with their pulse, I would mainly provide feedback on the pulse. At the same time, however, I might notice that the patient not only has a high pulse but also significant neck tension. If they’d told me beforehand that they always suffer from neck pain as well, then in this case I’d start by using the pulse as a ‘door-opener’, but I’d certainly incorporate the EMG into the treatment afterwards. That’s why I find it difficult to answer the question. I also like working with breathing, because you can influence it voluntarily and so you can work with it very effectively and quickly. We can also target specific muscles; although we often can’t simply relax them in a targeted way, we do have good control and can work with them quite effectively.
There are also cases in which skin conductance, in particular, reacts to stress. I think it is important to select the parameters based on the patients’ reports and also to check whether the parameters show a visible reaction.
Question: What do patients report? How do they notice that their anxiety symptoms are easing, and what long-term effects might there be?
Answer: In the short term, many patients notice that their breathing becomes slower and deeper, and that their heart rate also slows down as they breathe, which they can see on the screen. This gives them the feeling that they really can learn to relax. Many patients with anxiety believe they are unable to relax, but the physiological data often tells a different story. In the long term, patients with anxiety frequently report feeling less tense and being more relaxed overall. One example is a patient with an extreme fear of woodlice. Through biofeedback training, she was able to learn that, even when she thought about woodlice or saw them, although her heart rate would rise briefly in response, she could also quickly bring it back down again. This ability has helped her to overcome her fear and regain her freedom of movement.
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