Functional Respiratory Disorders by Ran D. Anbar

Author:Ran D. Anbar
Language: eng
Format: epub
Publisher: Humana Press, Totowa, NJ

Keywords

Resonance frequencyForced oscillationPsychological stressBaroreflexVagal trigeminal reflex loopAlternative and complementary medicineApplied psychophysiology

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Background

Biofeedback involves use of bioelectronic instruments to record physiological data and provide real-time information to an individual that is then used for the person to control his or her own physiology. The technique has been applied to many physiological functions, most frequently skin conductance, finger temperature, the surface electromyogram, various electroencephalographic variables, heart rate, and heart rate variability [1]. In the biofeedback procedure, the patient receives continuous information about a target physiological function (e.g., heart rate, surface muscle tension, palmar skin conductance) and uses this information to control that function. Although functions such as muscle tension and breathing can usually easily be controlled by this method in a relatively few sessions of training with close to 100% success, people appear also able to develop the coordination necessary to control various autonomic and neural functions, e.g., EEG rhythms at particular brain sites, finger temperature, skin sweating, blood pressure, and heart rate. The latter functions are more difficult to control, however, and require longer training, with more variable results. Although an autonomic function, however, heart rate variability is also easy to learn to control, because it can be directly manipulated by altering breathing patterns.

In principle, almost any physiological function that can be measured continuously can be used for biofeedback, and people can learn to use the feedback information to voluntarily control various physiological functions. Continuous measurement is necessary because most physiological functions continuously change, so the patient needs information about exactly when a particular function is heading in the “right” direction. Also, in the literature of operant conditioning, wherever positive reinforcement is given to “shape” a behavior by reinforcement for successive approximations, the procedure only is effective when reinforcement is delivered within seconds of the response. Delayed reinforcement usually impairs learning of new behavioral patterns [2, 3], although some learning with delayed reinforcement can take place, usually with less effectiveness [4, 5], thus demonstrating the positive but limited effects of such health care behaviors as frequent weighing to control obesity as components in behavior modification programs for overeating [6, 7].

Using biofeedback, people often are able to produce profound changes in most physiological parameters, within certain physiological limits. The method has been successfully applied to a number of disorders, most prominently including anxiety [8–11], Raynaud’s disease [12], headache [13], incontinence [14–16], depression [17–21], and attention deficit disorder [22–24]. In some respects, biofeedback is a component in various devices used medically and in daily life, without necessarily being identified as such. For example, biofeedback for respiratory behavior is built into almost all devices measuring exhaled nitric oxide, to insure that proper force of exhalation is achieved. Similarly, calibration of various spirometry devices often involves feedback to the operator of force applied to the plunger of a three-liter syringe. Even automobiles give biofeedback to the driver, by giving information about the force applied to the gas pedal (in the form of engine RPM’s).

Biofeedback may be particularly helpful for

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