relaxThere’s no greater skill to easing anxiety and physical tension, than learning to relax.  It sounds silly, perhaps, to think of relaxing as a skill, but think about how many times you’ve said or heard someone else say, “relax,” “calm down,” “settle down,” or “chill out.”  And, if you’re on the receiving end of that comment, it’s not as easy as it seems.

Yes, relaxation is a skill.  There are many paths to learning relaxation skills. I, personally, like progressive muscle relaxation (PMR).  An empirically supported approach to learning the difference between the experience of tension and the experience of relaxation, PMR is a guided practice of tensing and relaxing various muscle groups while engaging in diaphragmatic breathing.  Other approaches to gaining a self-soothing skill set include, guided imagery, diaphragmatic paced breathing, yoga, meditation, tai chi, and others.

Let’s discuss an often under-recognized, yet very useful, evidence-based approached to learning relaxation…biofeedback.  Biofeedback training involves heightening awareness of and gaining greater control of one’s own physiological processes through feedback from the ongoing processes.  Some of this feedback may include instruments that measure and provide feedback regarding heart rate variability (HRV), brainwaves (EEG), blood pressure, skin temperature/conductance, and/or muscle tension.

There is strong evidence for the use of biofeedback in health psychology, including efficacy in the treatment of:

  • Constipation
  • Irritable bowel syndrome
  • Migraines / tension headaches
  • Neuromuscular rehabilitation after traumatic brain injury or stroke
  • Temporomandibular Joint (TMJ) dysfunction
  • Urinary / Fecal incontinence
  • Phantom limb pain
  • Circulatory difficulties

Modest research has demonstrated the utility of biofeedback in the treatment of:

  • Anxiety
  • Sleep difficulties
  • Hypertension
  • Stress management

There are a number of other clinical problems that have been discussed in the biofeedback literature, but there is not yet evidence to support its utility with these presenting problems.

Biofeedback is a unique approach to learning to gain control over one’s physiological responses. I sometimes prefer it in providing treatment, as it gives a specific focus to relaxation practice and provides immediate feedback on one’s progress. For those who are intimidated at the idea of structured relaxation or for those who have difficulty controlling distraction by thoughts and other cognitive processes, biofeedback gives a focused goal to work toward.  And, when it works, it’s quite astonishing.  An experienced biofeedback practitioner, for example, can warm their hands in a matter of seconds by simply focusing on that task. Likewise, slowing heart rate, loosening muscle tension, and lowering overall arousal is easily accomplished by focusing on one’s bodily sensations.

Biofeedback equipment can be quite costly, but with our changes mobile technology, biofeedback tools have become much more affordable and accessible.  Although they do not replace biofeedback training with an experienced therapist with this skill set, these home-use devices/apps are great ways of achieving the relaxation response:

  1. Belly Bio – – a great app for the iPhone that brilliantly uses the device’s accelerometer to monitor proper diaphragmatic breathing.  Inexpensive and very useful.
  2. Mindfield eSense Skin Reponse ( and Mindfield eSense Temperature (app available at: , two unique apps that work with your iPhone or Android to provide skin conductance or temperature feedback with guided practice. To use the apps, the monitoring instrument, which connects to the phone must be purchased. The instruments are available at:  Mindfield Biosystems website:  A bit pricey, but much less expensive than many of its professional use counterparts.
  3. My Calm Beat – – A very nicely designed, inexpensive app for the iPhone or Android that personalizes and monitors paced breathing practice. Add-on modules, each at a low cost, are available, which include various paced breathing exercises and games.
  4. Breath Pacer – – A simple, inexpensive, paced breathing app available for iPhone or Android devices.


Have you had experiences with biofeedback?  Feel free to share.


Dr. Deibler


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