Beginning Biofeedback Therapy

Why go to the Biofeedback Therapist?
A biofeedback therapist is required when the problems that are experienced become greater than one can handle. Perhaps, medical help has been sought and the symptoms still exist; perhaps the idea appeals of participating in one's health utilizing the resources of the body. Biofeedback becomes an education or a journey toward inner awareness and self-management using the tools of feedback.

These may include instrumentation, dialogue with self and a therapist, and practice in various life situations, as well as in the biofeedback therapist's office. It requires dedication and time, and often a change in philosophy. It takes time to understand the physiology of the body and how to break a habit that may have existed for years before the symptoms appeared.

Despite a strong self-help component, it is prudent to do biofeedback under the care of a trained mental health professional, and only after medical evaluation has determined that a more serious condition isn't being "masked" by the training. Seeing a biofeedback practitioner is like going to see a trainer at the gym. The practitioner is there to guide the trainee by designing an individualized program for improved health, encouraging regular practice, monitoring results, and supporting the training process in various ways, including advice regarding complementary interventions.

What to expect when you go to Biofeedback
Initially, the biofeedback therapist will do a history of past health and of the current symptoms. Then a psychophysiological profile is done on the biofeedback equipment, which may include: 2 EMG sensors, one on the muscles of each shoulder, a temperature sensor to one fingertip and a sensor to measure hand sweat (called GSR, EDG or SCR). Occasionally, a measure of breathing skills will be done with strain gauges. Then, the client may be asked to do a variety of things during which the monitor will display the physiological responses. These may include reclining, sitting in a straight chair, standing, walking, talking of pleasurable things, relating stressful events, discussing symptoms, and relaxing during a guided meditation.

Some examples of the instrument readings follow:

EMG (Electromyograph) – In the event of a stiff neck and sore shoulders, the readings on the biofeedback computer may be elevated or variable, depending on body position or posture; alternatively one shoulder muscle may be more tense than the other, which will be revealed by a higher reading. That would have implications for the training.

Fingertip Temperature - Stress will cause cold hands. The biofeedback office is a new situation, so fingertip temperature may be low for that reason alone. As one is guided to relax with eyes closed, the temperature may rise. However, if it does not, this may simply be an indication to the therapist to continue monitoring. This is because efforting may be counter-productive, and change temperature in the wrong direction initially.

GSR (or EDG or SCR) - The levels of arousal can also be measured with the sweat gland activity of the hand. Loud noises such as sudden clapping, or relaxation with imagery can produce changes that are of interest to the biofeedback clinician. Baselines are taken in the first session under various conditions, against which future progress can be compared. Usually a more relaxed state yields lower readings.

RSA (Respiratory Sinus Arrhythmia) - This is a particularly sophisticated way of looking at arousal levels. The technique measures thoracic and abdominal breathing along with heart rate and skin temperature.

These findings are discussed with the patient in relationship to the presenting symptom. A discussion of the role of stress will be included. A plan for the future biofeedback sessions will be presented and, often, a relaxation tape will be sent home with instructions to begin "ownwork".

How to find a Biofeedback Therapist
Medical referral may be useful for purposes of insurance coverage. However you may find a listing in the phonebook, or call the state biofeedback association, or the national biofeedback professional organization, the AAPB (see references below).

Is Biofeedback covered by insurance?
Some insurance companies cover biofeedback services but often only for certain diagnoses. Such insurance corporation policies are subject to frequent change based on new input as well as customer demand. Some biofeedback therapists are able to bill the insurance companies, but many cannot due to certain restrictions set up by the insurance companies. In these cases, payment at the time of the visit may be required, but most likely a superbill (receipt) with treatment codes will be provided for submission to insurance. Reimbursement may take up to 6 weeks. Check with the insurance company using the following list so there will not be any surprises.

Some questions to ask the insurance company.

1. Do you cover Biofeedback?

2. If yes, is it under the Medical or Psychological or Physical Therapy part of the policy?

3. Will you pay for Biofeedback for (the particular symptom)?

4. At what rate do you reimburse?
i.e.: 80% of the usual and customary fee (Insurance companies often assign a fee they feel is appropriate); or, 80% of billed amount (Often the biofeedback therapist uses a fee that includes more time or other services)

5. What is my deductible?

Do I have any deductible left?

What is my co-payment?

6. For how many sessions of biofeedback will you pay?

a. Per year?

b. Before I see the doctor again?

7. Is there a limit of total amount paid out?
i.e.: the company may pay for biofeedback only up to $1500 in one year or six months.

8. If it is covered under medical, must I get a letter from MD to say it is medically necessary?

9. Do I need to send the letter to you before I see the Biofeedback Therapist, or can it go in with the first bill?

10. If I do not need a letter, do I need a prescription?

11. Is my doctor on the insurance provider list? If not, do you have provisions for unlisted providers?

12. What qualifications does the biofeedback therapist need to have? R.N., Ph.D., M.D., M.F.T. etc.?

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