Biofeedback in Somatoform Disorders and Related Syndromes
Biofeedback in Somatoform Disorders and Related Syndromes
Purpose of review: Patients often present with symptoms such as headache, muscle pain, non-cardiac chest pain, etc. that have no medical explanation. There is, therefore, the need for effective treatment options. Biofeedback has been suggested because of its goal to enhance control over the psychophysiological processes that may be involved. The aim of this review is to give an overview of the use and evidence of biofeedback therapy in somatoform disorders and related syndromes on the basis of recent publications.
Recent findings: Considerable evidence suggests that biofeedback is effective in tension-type headache (in adults and children), whereas its benefits in other conditions (e.g. fibromyalgia, non-cardiac chest pain) are less clear. Recent research has shown benefits for patients with formerly 'neglected' conditions such as vulvodynia and children's somatoform pain disorder. These results now need to be confirmed in larger randomized controlled trials. Biofeedback seems to be a highly credible intervention for patients suffering from somatoform complaints, and a useful tool to demonstrate body-mind connections.
Summary: It would appear that there is still the need to evaluate the efficacy of biofeedback for somatoform disorders, especially in conditions other than headache. Biofeedback seems to be a promising additional tool in cognitive-behavioural treatment programmes for somatoform disorders, but its role needs to be assessed in further controlled trials.
Medically unexplained symptoms can affect almost any body site, although some of the symptoms are more prevalent and are more likely to occur in the absence of disease than others. Common symptoms are, for example, headache, muscle and joint pain, low back pain, non-cardiac chest pain, and bowel symptoms. Many labels have been used in the literature, such as medically unexplained symptoms, functional symptoms, or somatoform disorders. Because of the considerable overlap between these syndromes, there is ongoing discussion about whether to give up separate classifications. The common factor among all the syndromes discussed here is the lack of a sufficient medical explanation. To diagnose a somatoform disorder, according to the Diagnostic and Statistical Manual of Mental Disorders, IVth edition, the bodily symptoms or concerns also have to result in clinically significant distress or impairment in functioning. Somatoform syndromes are quite prevalent in all countries. According to a cross-cultural study by the WHO, nearly 20% of primary care patients are affected by multiple somatoform symptoms. Many of the symptoms are transient, but a sizeable minority become persistent. There is thus the need for effective treatments and to incorporate them in regular healthcare management.
The aetiology of somatoform disorders is still not fully understood, but evidence supports an interaction of physiological, psychological and interpersonal factors. Although the lack of organic pathology is the central feature of the 'medically unexplained syndromes', current models of somatization consider benign psychophysiological processes to be relevant. There is some evidence of autonomic and neuromuscular dysregulation in patients with medically unexplained syndromes, such as heart rate reactivity, respiratory dysregulation, and smooth muscle contractions. It seems probable that some of these physiological processes contribute to the complaints. However, evidence is still inconclusive, and even less is known about the specificity of physiological processes in somatoform symptoms.
As the aetiology often remains unclear, the treatment can generally be described as an approach of 'coping rather than curing'. Looper and Kirmayer presented a model of mechanisms underlying somatoform disorders and corresponding treatment interventions: Biofeedback, relaxation training and stress management are suggested to address physiological and emotional arousal. Cognitive techniques, psychoeducation and attention training are suggested to alter cognitive-perceptual factors, and should be combined with the modification of illness behaviour and graded activity. This model outlines not only the possible role of interacting biopsychosocial mechanisms, but also the need for a multimodal treatment strategy.
The aim of this review is to give an overview of the use of and evidence on biofeedback therapy in somatoform disorders and related syndromes. As literature on biofeedback in somatoform disorders is rare, related syndromes will also be considered. The use of biofeedback has been recommended because of the possible psychophysiological processes that may be involved in the bodily complaints. Biofeedback is based on the measurement of autonomic and neuromuscular activity and the 'feed back' of them (in the form of auditory/visual feedback signals). The primary goal of biofeedback is to promote the acquisition of self-control of physiological processes that are otherwise outside awareness or under less voluntary control.
Purpose of review: Patients often present with symptoms such as headache, muscle pain, non-cardiac chest pain, etc. that have no medical explanation. There is, therefore, the need for effective treatment options. Biofeedback has been suggested because of its goal to enhance control over the psychophysiological processes that may be involved. The aim of this review is to give an overview of the use and evidence of biofeedback therapy in somatoform disorders and related syndromes on the basis of recent publications.
Recent findings: Considerable evidence suggests that biofeedback is effective in tension-type headache (in adults and children), whereas its benefits in other conditions (e.g. fibromyalgia, non-cardiac chest pain) are less clear. Recent research has shown benefits for patients with formerly 'neglected' conditions such as vulvodynia and children's somatoform pain disorder. These results now need to be confirmed in larger randomized controlled trials. Biofeedback seems to be a highly credible intervention for patients suffering from somatoform complaints, and a useful tool to demonstrate body-mind connections.
Summary: It would appear that there is still the need to evaluate the efficacy of biofeedback for somatoform disorders, especially in conditions other than headache. Biofeedback seems to be a promising additional tool in cognitive-behavioural treatment programmes for somatoform disorders, but its role needs to be assessed in further controlled trials.
Medically unexplained symptoms can affect almost any body site, although some of the symptoms are more prevalent and are more likely to occur in the absence of disease than others. Common symptoms are, for example, headache, muscle and joint pain, low back pain, non-cardiac chest pain, and bowel symptoms. Many labels have been used in the literature, such as medically unexplained symptoms, functional symptoms, or somatoform disorders. Because of the considerable overlap between these syndromes, there is ongoing discussion about whether to give up separate classifications. The common factor among all the syndromes discussed here is the lack of a sufficient medical explanation. To diagnose a somatoform disorder, according to the Diagnostic and Statistical Manual of Mental Disorders, IVth edition, the bodily symptoms or concerns also have to result in clinically significant distress or impairment in functioning. Somatoform syndromes are quite prevalent in all countries. According to a cross-cultural study by the WHO, nearly 20% of primary care patients are affected by multiple somatoform symptoms. Many of the symptoms are transient, but a sizeable minority become persistent. There is thus the need for effective treatments and to incorporate them in regular healthcare management.
The aetiology of somatoform disorders is still not fully understood, but evidence supports an interaction of physiological, psychological and interpersonal factors. Although the lack of organic pathology is the central feature of the 'medically unexplained syndromes', current models of somatization consider benign psychophysiological processes to be relevant. There is some evidence of autonomic and neuromuscular dysregulation in patients with medically unexplained syndromes, such as heart rate reactivity, respiratory dysregulation, and smooth muscle contractions. It seems probable that some of these physiological processes contribute to the complaints. However, evidence is still inconclusive, and even less is known about the specificity of physiological processes in somatoform symptoms.
As the aetiology often remains unclear, the treatment can generally be described as an approach of 'coping rather than curing'. Looper and Kirmayer presented a model of mechanisms underlying somatoform disorders and corresponding treatment interventions: Biofeedback, relaxation training and stress management are suggested to address physiological and emotional arousal. Cognitive techniques, psychoeducation and attention training are suggested to alter cognitive-perceptual factors, and should be combined with the modification of illness behaviour and graded activity. This model outlines not only the possible role of interacting biopsychosocial mechanisms, but also the need for a multimodal treatment strategy.
The aim of this review is to give an overview of the use of and evidence on biofeedback therapy in somatoform disorders and related syndromes. As literature on biofeedback in somatoform disorders is rare, related syndromes will also be considered. The use of biofeedback has been recommended because of the possible psychophysiological processes that may be involved in the bodily complaints. Biofeedback is based on the measurement of autonomic and neuromuscular activity and the 'feed back' of them (in the form of auditory/visual feedback signals). The primary goal of biofeedback is to promote the acquisition of self-control of physiological processes that are otherwise outside awareness or under less voluntary control.
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