המאמר הנוכחי מתבסס על סקירה שלYucha and Gilbert משנת 2004 בהמשך יובאו גם פרוטוקלים ספציפים יותר
AnxietyLevel 4 Efficacy (Efficacious)
Very few well-controlled, randomized studies have shown biofeedback to be superior toother relaxation and self-control methods for reducing anxiety. Most show biofeedback (EMG,GSR, thermal, or neurofeedback) to be roughly equivalent to progressive relaxation ormeditation. This may be because anxiety is less a disorder of physiology than of attention andcognition, and biofeedback monitors physiological changes. Lehrer, Carr, Sargunaraj, andWoolfolk (1994) evaluated the hypothesis that biofeedback is most effective when applied in thesame modality as the disorder (autonomic feedback for ANS disorders, EMG feedback formuscular, etc.). Self-relaxation techniques have in common the process of using conscious intentto calm oneself, and for anxiety reduction it may matter little which modality is used, because thecentral component is the cognitively-based conscious intent.
Two studies showed biofeedback's efficacy in reducing anxiety without makingcomparisons with other relaxation techniques. Hurley and Meminger (1992) used frontal EMGbiofeedback with 40 subjects trained to criterion and assessed anxiety over time using the State-Trait Anxiety Inventory (STAI). State anxiety improved more than trait anxiety. Wenck, Leu,and D'Amato (1996) trained 150 7th and 8th-graders with thermal and EMG feedback, and foundsignificant reduction in state and trait anxiety.Roome and Romney (1985) compared progressive muscle relaxation to EMGbiofeedback training with 30 children and found an advantage for biofeedback; Scandrett, Bean,Breeden, & Powell (1986) found some advantage of progressive muscle relaxation over EMGbiofeedback in reducing anxiety in adult psychiatric inpatients and outpatients. Vanathy, Sharma,and Kumar (1998), applying EEG biofeedback to generalized anxiety disorder, comparedincreased alpha with increased theta. The two procedures were both effective in decreasingsymptoms.Rice, Blanchard, and Purcell (1994) studied reduction in generalized anxiety bycomparing groups given EMG frontal feedback, EEG alp ha-increase feedback, EEG alphadecreasefeedback, a pseudo- meditation condition, and a wait- list control. All treatment groupshad comparable and significant decreases in the STAI as well as drops in PsychosomaticSymptom Checklist. Similar results were obtained by Sarkar, Rathee, and Neera (1999) bycomparing the generalized anxiety disorder response to pharmacotherapy and to biofeedback; thetwo treatments had similar effects on symptom reduction. Hawkins, Doell, Lindseth, Jeffers, andSkaggs (1980), concluded from a study with 40 hospitalized schizophrenics that thermalbiofeedback and relaxation instructions had equivalent effect on anxiety reduction. However,Fehring (1983) found that adding GSR biofeedback to a Benson-type relaxation techniquereduced anxiety symptoms more than relaxa tion alone.In conclusion, biofeedback of various modalities is effective for anxiety reduction; it isnot specific, but shares characteristics with other relaxation techniques.
References
Fehring, R.J. (1983). Effects of biofeedback-aided relaxation on the psychological stress symptoms ofcollege students. Nursing Research, 32(6), 362-6.
Hawkins, R.C. II, Doell, S.R., Lindseth, P., Jeffers, V., & Skaggs, S. (1980). Anxiety reduction inhospitalized schizophrenics through thermal biofeedback and relaxation training. Perceptual & MotorSkills, 51(2), 475-482.
Hiebert, B.A., & Fitzsimmons, G. (1981). A comparison of EMG feedback and alternative anxietytreatment programs. Biofeedback & Self Regulation, 6(4), 501-516.
Hurley, J.D., & Meminger, S.R. (1992). A relapse-prevention program: Effects of electromyographictraining on high and low levels of state and trait anxiety. Perceptual and Motor Skills, 74(3 Pt 1), 699-705.
Lehrer, P.M., Carr, R., Sargunaraj, D., & Woolfolk, R.L. (1994). Stress management techniques: Are theyall equivalent, or do they have specific effects? Biofeedback & Self Regulation, 19(4), 353-401.
Rice, K.M., Blanchard, E.B., & Purcell, M. (1993). Biofeedback treatments of generalized anxietydisorder: Preliminary results. Biofeedback & Self -Regulation, 18(2), 93-105.
Roome, J.R., & Romney, D.M. (1985). Reducing anxiety in gifted children by inducing relaxation.Roeper Review, 7(3), 177-179.
Sarkar, P., Rathee, S.P., & Neera, N. (1999). Comparative efficacy of pharmacotherapy and bio-feedbackamong cases of generalised anxiety disorder. Journal of Projective Psychology & Mental Health, 6(1),69-77.
Scandrett, S.L., Bean, J.L., Breeden, S., & Powell, S. (1986). A comparative study of biofeedback andprogressive relaxation in anxious patients. Issues in Mental Health Nursing, 8(3), 255-271.
Vanathy, S., Sharma, P.S.V.N., & Kumar, K.B. (1998). The efficacy of alpha and theta neurofeedbacktraining in treatment of generalized anxiety disorder. Indian Journal of Clinical Psychology, 25(2), 136-143.
Wenck, L.S., Leu, P.W., & D'Amato, R.C. (1996). Evaluating the efficacy of a biofeedback interventionto reduce children's anxiety. Journal of Clinical Psychology, 52(4), 469-473.