Orne, M.T. The efficacy of biofeedback therapy. Annual Review of Medicine, 1979, 30, 489-503.


Martin T. Orne, M.D., Ph.D.

The Institute of Pennsylvania Hospital and University of Pennsylvania, Philadelphia, Pennsylvania 19139


The effective functioning of any system--electrical, physiological, even social--is contingent upon the return of information to the system concerning its performance. The loop that provides the system with information about its output is called feedback. All of the homeostatic mechanisms of the body depend upon complicated interrelated feedback mechanisms that serve to stabilize the internal environment. Similarly, all skill learning depends upon knowledge of results. Practice makes perfect only if the individual is aware of how well he performs.

An illustration of the significance of feedback involves the acquisition of speech. The child learns to speak by imitating the sounds he hears, and the adequacy of learning depends upon his ability to compare the sound of the words he generates with that of the words generated by those around him. For this reason, individuals who become deaf later in life continue to speak without much difficulty, but children born deaf were, until relatively recently, unable to speak. Only when special techniques were developed by which the deaf person could learn the consequences of his attempts to speak, using visual and tactile cues to make up for his hearing deficit, did it become possible for totally deaf individuals to learn intelligible speech.

In a sense, teaching a deaf person to speak is an example of biofeedback. It involves providing alternative feedback channels to compensate for those not available to the individual so that he may acquire volitional control over a specific bodily function. It is therefore not surprising that the earliest applications of biofeedback were in the context of rehabilitation. These included not only teaching the deaf to speak or the blind to "see" with their



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hands and ears, but also retraining of muscles after injury or a paralytic disease, particularly when it was necessary for the individual to utilize the remaining muscle groups in a novel manner. Though the accomplishments of biofeedback in rehabilitation were impressive, the full implications of providing new channels of feedback to the individual were not generally appreciated because they were used to teach "ordinary" skills that are within the behavioral repertoire of most individuals.


The exciting aspect of the biofeedback technology that began to evolve during the 1960s is that it seems to provide methods to teach volitional control over physiological functions which were generally believed to be involuntary. Most of the research relevant to this work was published in psychological journals and is in large part couched in terms of a major theoretical controversy concerning the nature of visceral learning.

For many years it was accepted that physiological changes such as increases in heart rate, blood pressure, electrodermal response, alterations of brain waves, and the like could only be brought about in a reflex fashion. Classical Pavlovian conditioning, where the organism is essentially passive, automatically responding to what is being done to it, was seen as the mechanism of visceral learning. For example, a painful shock may elicit an increase in heart rate. If the shock is consistently preceded by a tone, the tone will begin to elicit the same response in a lawful, predictable fashion. The issue is not one of motivation; rather, the response is evoked involuntarily in a reflex-like manner, initially by the shock and subsequently by the tone as well. By using such procedures, any physiological change that could consistently be elicited involuntarily by a particular stimulus as an unconditional reflex could also be conditioned so that it would be evoked by different stimuli as a conditional reflex. It was assumed that "thoughts" could serve as conditional stimuli, and it was thereby explained how man could learn a modicum of volitional control over involuntary physiological functions.

An entirely different mechanism, however, was deemed relevant to the learning of volitional behavior. This process, known as instrumental or operant conditioning, depends upon reinforcing the organism when it is producing a desired response. In animal research, for example, the rate and consistency of lever pressing is easily controlled by the frequency and consistency with which the hungry animal is contingently reinforced (e.g. rewarded with food) when he makes the desired response. Whereas in Pavlovian conditioning the organism's "response" involves a change nor-



mal1y elicited involuntarily by a reflex, in operant or instrumental conditioning the response is any item of behavior within the organism's normal repertoire. In this sense, a reinforcer in this type of conditioning merely serves to make it worthwhile for the organism to do something that is already within its capabilities.

It seems somewhat strange, however, to request an individual to raise or lower his heart rate, since this would seem to be outside of his capabilities regardless of the rewards that might be offered. Thus, a two-factor theory of learning, classical conditioning for visceral learning and instrumental conditioning for the acquisition of skills and volitional behavior, originally outlined by Skinner (1, also see 2), was widely accepted.

Early Biofeedback Studies in Man

During the 1960s a number of investigators began to apply the operant model as a means of modifying visceral activity; in other words, negative and positive consequences contingent upon an apparently involuntary visceral response were used to modify that response. For example, Engel (3) initiated studies to control some cardiac arrhythmias. Noting that slight changes in heart rate would virtually eliminate the arrhythmias, he set about training patients to control their heart rate. Electronic equipment was used to compare the frequency on a beat-by-beat basis, and when subjects raised their heart rate even by a slight amount, a signal light was turned on. Engel then instructed subjects to keep the signal light on. Conceptualizing the light as a reward, he observed that subjects could indeed learn to increase their heart rate. Though the extent of control was limited, there was no doubt that subjects did indeed learn to alter their heart rate, and in some cases gained control over their arrhythmias. Control of heart rate in normal subjects was also documented by Shapiro et al (4), who went on to show that the change in heart rate was independent of changes in blood pressure. Kimmel (5), and subsequently Shapiro et al (6), documented operant control of the electrodermal response. Basmajian (7) showed that the firing of single motor neurons could similarly be brought under volitional control, a control sufficiently delicate to allow some subjects even to send Morse code in this fashion.

These studies, which were carried out largely with human subjects, seemed to show that, contrary to previous beliefs, appropriate technology could help individuals acquire volitional control over a number of different autonomic functions. Further, this control seemed to involve considerable specificity and could not be explained simply as the result of "thinking arousing thoughts." Nonetheless, there was considerable controversy concerning these studies, and a number of scientists were unwilling to accept the observations as compelling evidence that cortical control over auto-


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nomic activity had been demonstrated. Rather, they argued that subjects merely learned to change their physiological response either by playing mental games (taking advantage of classically acquired conditional reflexes with their thoughts) or perhaps utilizing covert muscular activity. It remained for Miller and his associates to document the radically new nature of the emerging technology.

Biofeedback Research with Animals

In a now classic paper Miller (8) reported a number of studies carried out on animals who were curarized--thereby eliminating the possibility of mediation by skeletal muscle activity--which documented that a variety of visceral responses could be brought under operant control. For example, heart rate and blood pressure could be varied independently of each other, intestinal motility could be altered, and the specificity of the responses was sufficiently great that it was possible to train rats to increase blood flow in one ear while simultaneously decreasing it in the other ear (9). It was shown that operant procedures could produce profound changes of medical relevance when 7 of 43 curarized rats trained to slow their heart rate died from apparent heart failure while none of the 41 rats trained to increase their heart rate showed such an effect (10). This experiment not only dramatized the power of this new procedure but also highlighted why some physiologically oriented scientists had difficulty from a teleological point of view in conceiving that nature would entrust such an important function as heart rate to the volitional control of any organism. Nonetheless, the work of Miller and his associates effectively provided the scientific legitimacy needed for the emerging field. It appeared to resolve the lingering doubts about the possibility of achieving instrumental control over physiological processes and seemed to justify a major effort to develop this new technology into a useful therapeutic modality.

Electroencephalogram Biofeedback

Another major area of interest developed independently and involved the work of Kamiya (11), who appeared to demonstrate that brain waves, most notably alpha wave activity, could be brought under operant control. Though brain wave activity had not really been considered analogous to visceral activity, it had nonetheless been assumed to be beyond volitional control. Kamiya not only seemed to document that subjects increased alpha density in a dimly lit environment but found that these increases appeared to persist beyond the training. His subjects reported that they preferred the experience of increasing alpha density to that of blocking alpha. Finally, he found that many subjects reported feelings that had traditionally been associated with meditative disciplines, such as calm, passive, relaxed, pleas-



ant, and the like, while producing large amounts of high density alpha in their EEG..l

The findings of Kamiya were widely reported in the media and supported by the work of Brown (12), Nowlis & Kamiya (13), Hart (14), and others. Though these studies tended to lack systematic controls, they nonetheless caught the imagination of many serious scientists as well as the media, a considerable number of technologically oriented individuals, and a sizable segment of the counterculture.

Other work in EEG control showed that individuals could be trained to control their evoked cortical response (15), to vary the amount of theta in their EEG (16), and even to gain control over the sensory motor rhythms that increased their threshold for convulsions, making this type of training a potentially useful treatment for epilepsy (18).


As has already been noted, the use of muscle tension feedback has a considerable history in rehabilitation. The application of this technique to lower the overall level of muscle tension did not develop, however, until the late 1960s. Stoyva & Budzynski (19) reported that frontalis muscle feedback could be employed to train people in general relaxation, and that while electromyogram (EMG) feedback was initially specific in its effects, it soon generalized so that as the tonic level of frontalis muscle tension was reduced, individuals became progressively more relaxed, indicated by the level of muscle tension in other muscle groups as well as in their verbal reports. This type of training has been widely applied in the treatment of tension headaches and has been used in the treatment of other pathology involving high arousal.

Another parameter used for biofeedback training is finger temperature. It has long been recognized that anxiety leads to peripheral vasoconstriction--the cold hand of the frightened individual. Objective psychophysiological studies have shown that finger temperature and forehead temperature vary inversely so that increasing finger temperature and decreasing forehead temperature are associated with increased relaxation and decreased anxiety. In the context of an early feedback study, Sargent et al (20) noted one of their patients who happened to have frequent migraine attacks became symptom-free in the context of an experiment involving training to raise finger temperature. This encouraging finding has led to the use of

1 Independently of Kamiya, Mulholland (17) reported that subjects could learn to increase or decrease alpha density. However, he did not generally observe the association between alpha density and subjective states reported by Kamiya.


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finger temperature training as a treatment of migraine, based in part on the logic that the same process that causes vasoconstriction of the forehead is likely to decrease the vasodilation of the cerebral vessels, which is the generally accepted mechanism underlying acute migraine attacks, with highly encouraging results.

As was noted earlier, alpha feedback training was similarly reported as leading to a relaxed, comfortable, anxiety-free state. Thus, mental and physical relaxation were seen as important consequences of several kinds of biofeedback training. The importance of relaxation in the clinical application of biofeedback led to a renewed interest in relaxation training without biofeedback. The history of such training as part of various meditative disciplines goes back to early antiquity. The more systematic and scientific study of relaxation training began with the work of Schultz (21) in Germany and Jacobson (22) in the United States. Schultz developed a procedure he referred to as autogenic training (23), which he saw as embodying the major healing aspects of hypnosis stripped of some of its mystical overtones. Autogenic training involved a series of learned exercises to induce calmness and relaxation. They included heaviness of the hand and, most interestingly, warmth of the hand, followed by training involving coolness of the forehead, evenness of respiration, and so on. This procedure, requiring a considerable period of training and extensive practice on the part of the student, was seen as producing predictable neurophysiological changes with profound salutary effects on a wide range of medical disorders. Though almost unknown in the United States until the 1960s, this procedure has long been widely used in the German-speaking countries and in Japan. There is an extensive clinical literature on the application of this technique (24).

The work of Jacobson (22) on the use of progressive relaxation stems from a somewhat different theoretical framework and focuses almost exclusively on learned muscle relaxation. While the procedures are somewhat different, the end result is to train individuals to be able to relax profoundly. Some of the salutary consequences ascribed to this technique show considerable overlap with those claimed for autogenic training.

Other procedures that have recently aroused modest scientific and considerable popular interest, such as transcendental meditation (TM), seem to produce similar kinds of physical and mental relaxation. Indeed, in their popular book, Benson & Klipper (25) discuss the relaxation response as a generic concept which has profound therapeutic effects for the individual.


Since biofeedback therapy involves both a novel approach to pathology and an effective technology, it has been applied to a wide range of medical



problems. The historical context that led to the introduction of biofeedback therapy is relevant because without the excitement generated among the public as well as within the profession the medical potential of biofeedback therapy would never have been realized. Fortunately, the clinical findings can now be evaluated on their merits, and the section below summarizes the results with some of the more important applications--results that, in some areas at least, are promising indeed.

It would be misleading, however, in an overview of this kind not to point out that the important studies with curarized animals that provided the scientific justification for much of the clinical research, while initially replicated, cannot now be reproduced. Though there is no difficulty in demonstrating statistically significant changes in visceral functions as a result of intrumental conditioning in curarized animals--leaving no doubt about the phenomenon--obtaining effects sufficiently large to be clinically significant eludes the present techniques (26). Similarly, alpha feedback training, which inspired much of the initial interest in biofeedback, has not thus far lived up to its initial promise (27). Finally, the techniques of biofeedback that have the potential of being extremely specific in their action, modifying one visceral response without altering other closely related visceral responses, have rarely functioned in this way when applied clinically. With a few important exceptions, therapeutic effects associated with biofeedback are accompanied by general relaxation and decreased arousal. Thus, while conceptually biofeedback tends to be viewed as a specific therapy, in practice the more general effects of relaxation may play a disproportionately large role in achieving the therapeutic effects.


Disorders of Cardiac Rate and Rhythm

Numerous studies have shown that normal individuals can be trained to increase or decrease their heart rate reliably, though the degree of change will depend on baseline levels and the individual's overall normal cardiac variability, as well as on the kinds of inducements and other details of the procedure.

This procedure has been used successfully to treat sinus tachycardia, supraventricular tachycardia, and atrial fibrillation by training patients to slow their ventricular heart rate. Pharmacological studies carried out with the latter condition suggest that efferent vagal activity mediates this ability. Further, at least one patient with Wolff-Parkinson-White syndrome was trained to increase or decrease normal AV conduction, again by modifying efferent vagal activity. A group of eight patients with premature ventricular contractions (PVCs) were trained to decrease the number of PVCs by first being taught to increase, decrease, and maintain their heart rate within a


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narrow range. Five of the eight patients showed a decrease in PVCs during the course of training (28). Training to control PVCs, as well as other efforts to modify clinical disturbances of cardiac rhythms, requires considerable time. In the cited study, for instance, participation in over 47 training sessions was correlated with improvement. The long-term results of training, however, are variable. One patient showed a reduction of PVC frequency from about ten per minute to approximately one every five minutes by the end of the study, maintaining this improvement for several years. Another patient who reduced her PVCs from twenty per minute to none for approximately fifteen minutes during training did not maintain this improvement at the end of the training period. (For reviews of these studies see 29,30.) Though the demonstration of learned control over some aspects of cardiac dysfunction is dramatic, other recent work suggests that relaxation training alone may be effective in reducing PVCs (31). While relaxation training does not have the specificity of action seen with biofeedback, the importance of relaxation for clinical improvement, as previously mentioned, deserves attention. In sum, findings to date justify continuing research but do not suggest that biofeedback therapy is ready to be considered as an alternative to accepted drug therapy except on an investigative basis.

Raynaud's Disease

The painful paroxysms of cutaneous vasospasm that characterize Raynaud's disease have been successfully treated with temperature feedback training of the affected limb. Patients with Raynaud's disease can learn to increase finger temperature as readily as normal individuals, and with adequate training are able to raise finger temperature from the occasionally depressed level to the normal range and maintain it there even when challenged by cold pressor tests and other kinds of exposure to cold environments.

A number of individual case reports and series of cases, including one large series of 80 patients, reported excellent results following digital temperature feedback training (48). It would appear important that patients learn to maintain and self-regulate the increase of temperature over a period of time and to retain this ability when feedback training is completed. However, a successful result also depends upon being able to do so without feedback and to maintain the increased finger temperature while carrying on concurrent activities. (For a review, see 32.)

Though the results with Raynaud's disease are extremely encouraging, it should also be recognized that the syndrome can be precipitated by emotional upset and is importantly influenced by psychogenic factors. Further, relaxation training in general and autogenic training in particular, which involves the use of self-suggestive phrases such as "My hands are



heavy and warm." have been used with generally good results, and in one recent study of Raynaud's disease (33) both autogenic training procedures and biofeedback training yielded excellent results that did not differ from each other.

Related vasoconstrictive disorders apparently responsive to biofeedback training include acrocyanosis, scleroderma, pernio syndrome, and trench foot. While the reported results are promising with each of these conditions, further study is needed.

Biofeedback therapy is without any serious side effects and thus would be preferable to either drug therapy or sympathectomy. A therapeutic trial of biofeedback should be initially undertaken and, if effective, should become the treatment of choice for Raynaud's disease.


True migraine is characterized by arterial dilation of the cerebral circulation, and there are numerous reports of its successful treatment by training patients to increase finger temperature, thereby inducing a reflex or reciprocal constriction of the cerebral circulation. The reported results range from 50% to over 70% improvement. Cases of classical migraine, with a clear aura and a typical course, respond best (20,34). There is some controversy, however, whether handwarming is necessarily the specific treatment or is effective only as part of more general relaxation training. Thus, Price & Tursky (35) compared temperature feedback, relaxation training, and a neutral control group; they reported that either type of active treatment was far more effective than the control--supporting the view that learning to increase blood flow of the hands may only reflect a general autonomic relaxation.

Though it is not clear whether handwarming is the specific therapeutic agent or whether it involves the concomitant learning of relaxation, the clinical results reported are positive, and either temperature biofeedback training or other forms of relaxation training are safe and generally effective therapeutic procedures for this ubiquitous and ofttimes extremely troublesome malady.

Tension Headaches

Tension headache is typically accompanied by muscle spasms of the head and neck. Feedback of muscle tension, based on the electromyogram (EMG), typically of the frontalis muscle, has been used with considerable success. A number of studies report lasting results with those patients who not only learned to lower muscle tension but also to carry out relaxation exercises at home (36). Here again it remains to be established whether EMG feedback is uniquely important or whether temperature feedback or


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relaxation training may be equally effective. Since most clinicians using biofeedback in the treatment of tension headaches employ a combination of these techniques, this is largely a matter of only academic interest. Clinical results have been sufficiently encouraging to justify a therapeutic trial of biofeedback for this condition.

Hypertension and Hypotension

Following reports that large and persistent changes in blood pressure could be produced in curarized animals using feedback procedures, there was considerable interest in the use of biofeedback for the treatment of high blood pressure. Several studies (37, 38) reported consistent significant decreases during feedback sessions. Typically, a large number of training sessions were required and the decreases were generally not very large. In the Benson study (37) of patients with elevated systolic blood pressures, three of seven patients' blood pressures returned to normal limits, while in the Schwartz & Shapiro study (38) of patients with elevated diastolic pressures, only one of the seven patients showed a clinically meaningful decrease. There are few reports of follow-up, and those that are available indicate that the patients do not tend to maintain the decreased blood pressure. Similar results have also been reported with various kinds of relaxation procedures.

While the treatment of hypertension with presently available biofeedback technology is neither particularly effective nor necessarily specific in its action, dramatic and clinically useful work has been carried out in the treatment of hypotension following spinal cord injuries. Miller and his associates (39, 40), treating paraplegics unable to maintain a vertical position without fainting due to hypotension, have been able to teach a number of such patients sufficient control to maintain satisfactory levels of blood pressure. Though this application is relevant to a very select group of patients, its consequence is nonetheless dramatic and suggests the merit of further research to determine the conditions under which man can learn to regulate his own blood pressure.


Biofeedback in the form of muscle tension training, followed by training to increase theta waves (4-7 cycles per second EEG activity), has been reported to be effective in the treatment of insomnia (41). A number of reports also indicate that relaxation training, in the form of either progressive relaxation, autogenic training, TM, or self-hypnosis, is effective in the treatment of insomnia. Thus, while biofeedback may play a role, it has not yet been documented as more effective than the simpler and more readily available forms of relaxation training. Relaxation training, with or without



biofeedback, is safe, tends to increase the patient's feeling of mastery, and should be considered for the treatment of chronic insomnia (for a review, see 42).

Neuromuscular Rehabilitation

As discussed previously, some of the earliest uses of biofeedback were in the area of rehabilitation. A variety of feedback procedures have been employed with considerable ingenuity and success. There is little doubt that feedback procedures should have a role in the rehabilitation of a wide range of patients with sequelae of trauma, CVAs, and some neurological disorders (for a review, see 43).

TORTICOLLIS This notoriously recalcitrant syndrome has been treated with muscle feedback, relaxation training, and other behavioral procedures with varying success. In a large series, Brudny et al (44-46) used muscle feedback and what the authors call sensory feedback therapy with a group of 40 patients serving as their own controls. Patients were assessed physiologically and evaluated for the degree of head tilt by video tape before and after 8-10 weeks of training. Auditory and visual EMG feedback were used to teach patients to diminish the contraction of the hypertrophied sternocleidomastoid on the ipsilateral side and to increase the contraction of the corresponding atrophied muscle on the contralateral side to achieve postural control. Fifty-six percent of the torticollis patients showed significant clinical improvement and profound positive changes in daily living. Forty percent of the patients maintained improvement at three-months follow-up. Results to date indicate that biofeedback procedures may therefore be useful in the treatment of torticollis; however, for maximal effectiveness, it is likely that they will need to be combined with other behavioral and psychological approaches.

INCONTINENCE One of the most clear-cut and specific uses of biofeedback demonstrated to date is its application to the treatment of fecal incontinence. When the rectum or rectosigmoid colon is stimulated by distention comparable to that produced by fecal matter descending into this area, there is a reflex relaxation of the internal anal sphincter, which normally is compensated for by a brief contraction of the external anal sphincter, preventing the escape of stool at inappropriate times. In many cases of fecal incontinence the external sphincter response is absent or weak, often the sequela of pelvic surgery, trauma, or various neuropathies. A procedure for retraining sphincter control in patients with this type of fecal incontinence was reported by Engel et al (47). Two balloons are used to measure the response of the internal and external sphincters respectively, and a third


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balloon is inflated in the rectum to simulate fecal material by producing internal sphincter relaxation and external sphincter contraction. The patient is shown the correct response and his own on a strip recorder and told what he should try to do. The rectal balloon is repeatedly inflated with air and the patient is verbally praised for successfully approximating the desired response. As he improves, the amount of stimulation is progressively decreased until the appropriate external sphincter response is made to the weakest stimulus likely to occur.

The first report included six patients, four of whom became completely continent after treatment, and the other two much improved. Subsequently, an additional 50 patients have been studied, and 72% of these were either completely continent or at least 90% improved after treatment. Two or three training sessions at monthly intervals were usually sufficient for therapeutic results. Considering the surgical alternatives, this is an instance where a safe, simple, and relatively inexpensive procedure can reverse an extremely embarrassing symptom and dramatically enhance the quality of the patient's life.

Though various kinds of general biofeedback therapies have been used for urinary incontinence, no procedure analogous to that for the treatment of fecal incontinence has thus far been applied. It would seem a relatively simple matter to adapt urological procedures to the biofeedback mode, and one might reasonably expect positive results with some types of bladder dysfunction and urinary stress incontinence.


Biofeedback is an exciting new technology, particularly since it helps the patient himself gain mastery over his own difficulty and ultimately to become his own therapist. The information fed back to the patient, usually on a fairly continuous basis, can also be recorded in ways helpful to the physician in assessing the patient's problems. In many circumstances, information that can document gradual improvement is particularly helpful to patients in allowing them to recognize progress which would not otherwise be obvious. This kind of information is likely to be helpful in maintaining the patient's motivation. Further, biofeedback helps the patient take an active role in his own therapy, an aspect especially important in the treatment of chronic conditions.

Biofeedback therapy does not, however, take place in a vacuum, and the, nature of the doctor-patient relationship and other psychological factors will profoundly affect the results of biofeedback as well as those of any other therapy. In addition to the information that biofeedback provides by way of an external feedback loop, the various procedures designed to reward the



patient for his performance can, in their own right, play an important therapeutic role. It is also clear that for certain conditions, as in other therapies, some systematic program of follow-up treatment is needed to maintain continuing progress.

While there are some highly promising specific effects of biofeedback-- as in the treatment of fecal incontinence--it is also clear that most biofeedback therapies involve training the patient to decrease his level of physiological arousal and therefore serve to bring about the same end results as a wide variety of relaxation therapies. However, the fact that relaxation therapy is often as effective as biofeedback ought not discourage us from the use of biofeedback but rather lead us to recognize the importance of gaining control over those continuing states of hyperarousal that are related to the whole gamut of stress related symptoms. In a sense, the dramatic technique of biofeedback, employing as it often does the most advanced technology, helps to remind us of the close association between subjective experience and the homeostatic mechanisms controlled by the autonomic nervous system. Further, it has reawakened interest in relaxation training procedures that are perhaps as old as man and can be found in virtually every culture. The techniques of biofeedback have thus not only shown themselves to be therapeutically effective in a number of stress related problems but also have provided the means of both inducing and assessing various forms of mental and physical relaxation, the importance of which has only begun to be rediscovered in modern medicine.


I would like to express my appreciation to my colleagues, Peter B. Bloom, David F. Dinges, Frederick J. Evans, Emily Carota Orne, William M. Waid, and Stuart K. Wilson, for their suggestions and critical comments in the preparation of this manuscript. The substantive work carried out in our laboratory relevant to this paper and its preparation was supported in part by grant MH 19156 from the National Institute of Mental Health and by a grant from the Institute for Experimental Psychiatry.


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The preceding paper is a reproduction of the following article (Orne, M.T. The efficacy of biofeedback therapy. Annual Review of Medicine, 1979, 30, 489-503.) It is reproduced here with kind permission from the Annual Review of Medicine, Volume 30, © 1979, by Annual Reviews http://www.annualreviews.org