Post-traumatic stress disorder and biofeedback
The lifetime prevalence of post-traumatic stress disorder (PTSD) is around 8 %1, but may be significantly higher among particularly vulnerable groups, such as refugees2. PTSD is one of the most common mental health disorders and can be triggered by traumatic experiences or highly stressful situations. Those affected often suffer from so-called flashbacks, during which they involuntarily relive the traumatic experiences.
Biofeedback as a treatment approach for PTSD
In the treatment of PTSD with Biofeedback For example, breathing exercises can be used as a complementary treatment alongside cognitive behavioural therapy3. However, work on respiratory sinus arrhythmia/the Heart rate variability (i.e. the synchronisation of breathing and heartbeat) is utilised4.
If people are exposed to stress at short intervals and/or on a regular basis, an (otherwise only temporary) increase in muscle tension can become a permanent condition. This is why, particularly in the case of traumatised pain patients, the EMG biofeedback used to reduce chronically elevated muscle tension5.
Effectiveness
In the biofeedback review published by the Association for Applied Psychophysiology and Biofeedback, entitled „Evidence-Based Practice in Biofeedback and Neurofeedback“, biofeedback was classified as „likely to be effective“ for the treatment of PTSD6. Dr Liedl and her colleagues have also published a manual on the treatment of traumatised pain patients, which includes biofeedback training5.
A study examining HRV feedback in veterans with PTSD suggested that biofeedback is an effective treatment for this group4. In a further study, respiratory biofeedback proved to be a practical and easily integrated treatment method for post-traumatic stress disorder. Compared with a control group (cognitive behavioural therapy), the respiratory biofeedback group (respiratory biofeedback plus cognitive behavioural therapy) showed a significantly faster reduction in symptoms3.
A real-life example
Dipl.-Psych. Andres Kruse from the Oberammergau Rheumatology Centre provides a relevant practical example:
In cases where post-traumatic stress disorder has been diagnosed through differential diagnosis, we have recently begun using biofeedback as part of a short-term treatment programme (given that our treatment lasts 2 to 3 weeks) based on the approach of Liedl et al. (Trauma and Pain, Schattauer 2013) to help participants achieve greater emotional detachment from the distressing (and pain-intensifying) experience of flashbacks and intrusions.
The clear visual feedback on psychophysiological parameters makes it easier for participants to identify and practise the self-calming and self-distancing techniques that are right for them.
Detailed report on the study
Trauma-focused cognitive behavioural therapy with exposure has so far proved to be a highly effective treatment for post-traumatic stress disorder (PTSD). However, not all those affected benefit equally from this form of therapy. A research team led by Dr Olff from the Department of Anxiety Disorders at the University of Amsterdam therefore investigated the supportive effect of respiratory biofeedback in the treatment of PTSD. The participants were assigned either to a group receiving standard cognitive behavioural therapy or to a group receiving supportive respiratory biofeedback treatment.
Results and conclusions of the study
Breathing biofeedback proved to be a practical and easily integrated addition to standard treatment. Positive effects were observed in both groups. However, the respiratory biofeedback group showed a significantly faster reduction in PTSD symptoms.
These findings suggest that biofeedback could be a promising addition to conventional treatment for PTSD. Further research in this area is therefore recommended in order to further explore and optimise the potential of this form of treatment.
Biofeedback for:
ADHD
Anxiety disorders
Asthma
Profession
High blood pressure
Depression
Epilepsy
Erectile dysfunction
Incontinence
Competitive sport
Raynaud's disease
PTSD
Rehabilitation
Irritable bowel syndrome
Sleep disorders
Stress & burnout
Stress diagnostics
Pain therapy
Tinnitus
Constipation
Sources:
1 Kessler, R. C., Sonnega, A., Bromet, E., Hughes, M., & Nelson, C. B. (1995). Post-traumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry, 52(12), 1048–1060.
2 Steel, Z., Chey, T., Silove, D., Marnane, C., Bryant, R. A., & Van Ommeren, M. (2009). Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement: a systematic review and meta-analysis. *JAMA*, 302(5), 537–549.
3 Polak, A. R., Witteveen, A. B., Denys, D., & Olff, M. (2015). Breathing biofeedback as an adjunct to exposure in cognitive behavioural therapy accelerates the reduction of PTSD symptoms: a pilot study. Applied Psychophysiology and Biofeedback, 40(1), 25–31.
4 Tan, G., Dao, T. K., Farmer, L., Sutherland, R. J., & Gevirtz, R. (2011). Heart rate variability (HRV) and post-traumatic stress disorder (PTSD): a pilot study. Applied Psychophysiology and Biofeedback, 36(1), 27–35.
5 Liedl, A., Knaevelsrud, C., & Müller, J. (2013). Trauma and Pain: A Manual for the Treatment of Traumatised Pain Patients. Schattauer Verlag.
6 G. Tan, F. Shaffer, R. Lyle, & I. Teo (Eds.). Evidence-based practice in biofeedback and neurofeedback (3rd ed.). Wheat Ridge, CO: Association for Applied Psychophysiology and Biofeedback.