Respiratory Biofeedback RFB.micro
Introduction for the Doctor with Practical Suggestions
Introduction for the Doctor with Practical Suggestions
Respiration Feedback in Medical Practice
In German - speaking medicine autogenous training (AT) is, at present,
the best understood and most widely used method of psychotherapy. The
scientific researcher J. H. SCHULZ, who developed this ingenious system
of con centrative self-relaxation, devoted decades of work to the
testing of its broad spectrum of indications as relaxation therapy. It
comprises all "nervous" or neuro-vegetative, therefore
functional or conversion neurotic clinical pictures, psychosomatic
diseases such as Asthma bronchiale, Colitis ulcerosa, essential
hypertonia, etc. But, after thorough practice in this pragmatic method,
the patient can also learn to control, more or less himself,
psychoneurotic symptoms, such as states of anxiety, slight depressive
neuroses and character maladjustments. Principally, therefore, those
30-40% of all patients who suffer from diseases with psychological or
partially psychological causes can be treated by AT. But, as is
well-known, this method can also help healthy people, by means of the
"prophylactic pause", to reduce and prevent stress to which
ever-increasing numbers of the population are exposed nowadays.
The AT therapy requires that the doctor himself masters the method and
personally instructs his patient in it. The patient must meet certain
requirements of intelligence, emphaty and strength of character with
regard to the regular exercise he has to perform himself.
The effect of AT depends, to a certain extent, on the feedback to the
cerebral cortex of the state of muscular tension (sense of heaviness),
of the vascular circulation (experience of warmth), of the respiratory
process (respiratory control), and the blood circulation in the
epigastrium ("solar plexus"); this is achieved by a gradually
increasing awareness of the above-named vegetative body functions. It is
only after months of continuous practice that the patient achieves the
decisive control of these functions ("Practising method").
During the last decade there has been a tendency in scientific research
in the USA to use electronic instruments for such
"Bio-Feedback" processes. The aim of these experiments, as far
as they are concerned with therapeutic application in human beings, has
been to create a state of modified consciousness and of relaxation,
similar to that achieved by AT. Out of the various possibilities,
however, only two bio-feedback systems have emerged which, on the
strength of broad basic research, may claim to be of clinical interest.
These are the feedback of muscular actions by means of the
Electromyelograph (EMG-feedback) for the treatment of migraine and
tension headache, and the control of the heart action in cases of
cardiac disorders. The latter procedure is still on trial.
In Germany a group of researchers worked along different lines. They
examined the feedback of the respiratory movement, referred to as
"Respiration Feedback" (Rfb) under its scientific designation,
or as "Breathing Feedback" in its practice-related name.
Professor Hanscarl Leuner, neurologist and psychotherapist, Head of the
Department of Psychotherapy and Psychosomatics of the teaching hospital
of Göttingen University, who is well-known for his many years of
research in the field of modified states of consciousness, observed that
physical-psychological relaxation (Hypnoid) and respiratory type
correlate in a certain way (e.g. in AT, sleep, coma, during Yoga and
meditation exercises). Since 1970 he and his study group have been
developing and testing an electronic apparatus which scans the
respiratory movement by means of a sensor on the patient and converts it
without delay by amplification into an optical and/or acoustic signal,
that is, translates it into a light of increasing and decreasing
intensity and/or a tone (headphone) of changing pitch. The patient is
thus distinctly aware of his breathing rhythm and his respiratory rate,
without requiring any prior training. Prof. Leuner's expectations were
not only confirmed, but in part even exceeded during the physiological
and clinical trials. The EEG distinctly shows a considerable reduction
in cerebral activity and thus the state of wake-fulness. It exceeds the
EEG-changes during hypnosis, AT (and Alpha-Feedback) in the sense of a
marked reduction of violance. At the same time the muscular tone (sense
of heaviness in AT and in EMG-feedback) is distinctly reduced. There is
a strong subjective awareness of the psychological influence of the
procedure, which runs parallel to this physical "conversion"
("Umschaltung", J. H. SCHULZ ). It was possible to establish
this statistically with significant frequency by means of the semantic
differential ("Polaritätenprofil", HOFSTÄTTER ) in the
following adjectives of subjective experience: "relaxed, at ease,
indifferent, composed, comfortable, sure, safe, free, light,
The clinical trial of Rfb was carried out on a random group of 200
outpatients. They came from a medical and a psychiatric policlinic of a
teaching hospital as well as from a neurological practice (ages 18-50
years, average age 33 1/2 years, average duration of symptoms 4 years).
Patients with psychoses and internal diseases were excluded. The
complete course of treatment consisted of 15 half-hour sessions and was
to be supported by a further 8 sessions. After about 5 sessions at the
latest the above-mentioned state of deep relaxation was achieved. Just
under 90% of the patients felt that the treatment was agreeable, about
50% were willing to continue with it, in over 70% an objectively
adequate to very good improvement of their symptoms could be observed. A
comprehensive paper is available on request.
What are the Advantages of Respiratory Feedback?
The time required for the instruction in relaxation is cut down
considerably; the tangible therapeutic effect manifests itself within
The training aim is achieved with a high degree of certainty.
The state of relaxation is intensive, and thus especially efficacious.
Rfb makes no demands on empathy, intelligence or will-power on the part
of the patient, except for the ability to yield to the state of
The method is therefore suitable for patients of all social groups.
The doctor need not himself have learned the procedure. The training of
the patient can largely be left to trained auxiliary personnel (training
courses on request).
Indications: Generally speaking: almost all conditions for which
neuro-vegetative or the well-known minor tranquillizers are prescribed,
or where AT is indicated; vegetative-functional disorders of all kinds
(after an organic background has been eliminated), so-called conversion
neuroses or psychosomatic states, but also psycho-neurotic symptoms,
such as states of anxiety, phobias, slight depressive neuroses, as well
as the group of acute or chronic stress-related reactions. Stress
prophylaxis in stress susceptible asthenic persons or persons exposed to
statistical survey of the groups of diseases, the change of the test
profiles and some individual reports by patients are available. Only
about 5% of an unselected group of patients proved totally unsuitable
for the treatment.
Contra Indications: Severe psychiatric symptoms, such as psychoses or
suspected psychoses, or borderline cases, an abnormally restricted level
of intelligence, imaginary of the patient with regard to the method or
its rejections for any other reasons (clarifying discussion before
External Conditions: A quiet, darkened exercise room, positioning of the
apparatus, comfortable couch (with BIOSWING-System are the best),
auxiliary personnel trained in the procedure (with first-hand
experience, i.e. introduction by means of a course organized by MFB.
Time Schedule: One exercise takes 30-40 minutes. Double sessions are
also possible. Including contact conversation, fitting of the sensor and
brief concluding discussion, 50 minutes have to be allowed per session.
A course of treatment consists of 15 sessions. 3-4 sessions per week
should be carried out, depending on the severity of the symptoms. If the
patient refuses to continue with the treatment after 5 sessions (as is
extremely rarely the case), or if he believes that he does not benefit
from the treatment, Rfb is not indicated.
After-treatment: 8 sessions, once weekly, are recommended in order to
maintain the effect. Occasionally patients avoid the after-treatment if
they are feeling well. In the concluding discussion an offer of
after-treatment should be made which the patient may take up if he
should experience renewed difficulties at a later date. After the course
of treatment is completed the doctor should conduct a brief concluding
orientation discussion, in order to form an impression of the effect of
Rfb and to determine further therapy accordingly.
Medication: During the treatment with Rfb an attempt should be made to
discontinue any neuro-vegetative and/or sedative medication. In cases
where medication is indispensable, the dosage should be reduced to a
minimum and then kept at a constant level (Instruction of the patient).
Interference Factors: In the treatment with Rfb these may arise from
circumstances connected with the patient's own psyche, such as imaginary
Leuner, H.: Das Respiratorische Feedback (Rfb), intensive
Entspannungstherapie und ihre klinischen Ergebnisse bei Neurosen und
Feedback in Medical Practice
results of a survey of 20 practicing doctors - mostly general
practitioners, but also some neurologists - who have been treating
patients with Respiration Feedback (Rfb) for years is a clinical
illustration of the Rfb's importance in basic medical treatment. The
essence has been collected in 6 categories.
of practicing Physicians
their practices Rfb is an "indispensable therapy
to continuous prescription of psychopharmalogical drugs
(tranquillizers, sedatives and sleeping pills) Rfb saves money. The
desired - but unnecessary - special examinations, as CT, etc., which
are liked with insufficient treatment also cease. Through
Rfb-relaxation patients often become convinced of the functional
character of their complaints.
technique demonstrates a counteractive effect against dependence on
alcohol and medication; due to the rapid symptomatic improvement,
prescription of medication is unnecessary and / or addicted patients
can "better withstand withdrawal."
relationships to autogenous training are characterized as follows:
"better and more rapidly effective than AT"; not dependent
on the mental level of the patient; a great help in the practice of
is an aid in the psychotherapy of patients, who are not motivated
and open for it. For patients, who do not have the prerequisites for
psychotherapy, Rfb can be substituted for it.
reports express a lack of understanding over the fact that Rfb was
excluded from payments of German health insurance by a decision of
the State Board of Health in April 1986 and are pleading or have
filed a petition for the inclusion of Rfb in the current revision of
the Health Insurance Assessment Regulations.
B. from Oberndorf
"Since I work in a rural area, my clientele consists primarily of
workers, part-time farmers, about 10% foreign workers and their
dependents. Many patients are prejudiced against medication. When they
come to my office with medical complaints, many of them do not have the
prerequisites for autogenous training, but Rfb is suitable for them. . -
The patients response/resonance to the Rfb treatment greatly exceeds my
original expectations. -Indeed, the fact that over 80% of the patients,
who have gained just a little experience with Rfb, often arrive
punctually after travelling many miles for their relaxation session
speaks for itself..." - "At last after the tenth session,
after which another consultation takes place, I observe an increasing
self-confidence, tranquillity and a more realistic attitude by the
majority of my patients. Even skeptics repeatedly express this opinion:
"As simple as the method is, it helps me."
My colleague further described a case of crisis intervention with Rfb:
"A highly agitated middle-aged man came into my practice while I
was making house calls. He panicked because no one could give him the
necessary sedative injection. In this situation it was possible for my
technician to talk him into undergoing Rfb. As I arrived about 35
minutes later, he said, "I'm O.K. now, I don't need an injection
W. from Wuppertal (general practitioner)
I have been working with this method for more than two years and I
cannot imagine working without this psychiatric therapy spectrum.
Insomnia, agitated depression and neuroses, psychiatric complaints
arising during withdrawal from, e.g., alcohol and nicotine, nervous
behavioral disturbances and any other disorders are readily and
lastingly susceptible to Rfb. Our own statistics show that much more
than 90% of our patients have (first) remained for the total therapy
period of 20 sessions ... and (second) that after completing the therapy
the patients spontaneously expressed their enthusiasm about its success.
All of my patients who have been treated with Rfb either no longer need
medication, such as tranquillizers, or that they are motivated to stop
using them. So-called "quitters" are extremely seldom. In
spite of the great amount of time required for this therapy (one hour
2-3 times per week), none of the patients have ever complained... Both
in terms of the method and the effect, Rfb is located between autogenous
training and hypnosis. This has been particularly confirmed by the
patients who had previously attended autogenous training courses. The
dropout rate of AT courses is known to be much higher. These patients
consider Rfb to be distinctly more effective. Rfb is also very useful as
an adjuvant in psychotherapy.
This method does not directly require an intensive investment of the
doctor's time, but it does mean a not inconsiderable burden for the
operation of practice: a room which is nearly soundproof and a
comfortable variable-position couch must be made available... The
physician must keep track of the success of each completed session, so
that he may correctively intervene if necessary. In difficult cases the
physician must also ... suggestively influence the program."
Shearouse RRT, Respiratory Associates Inc. West Palm Beach, Florida
Introduction: I sought to determine whether patients suffering from COPD
would benefit from respiratory biofeedback (RFB). RFB is accomplished by
using an amplifier that feeds the respiratory rhythm to the reticular
formation found in the brain. The biofeedback loop starts at the sensor
that scans the patient's breathing rhythm. The sensor is connected to an
amplifier that converts the electrical impulses into acoustical and
visual outputs. These outputs are transferred to the patient by a
headpiece, which is made up of an eyeshield with lights and stereo
earphones. Outputs increase and decrease in volume and intensity as the
patient inhales and exhales.
Methods: 10 patients were treated using the RFb 5000 (RFB Technologies,
Boca Raton FL). I measured O2 saturation (SpO2) via a Nellcor N-200
before, during, and after treatment. Patients' dyspnea scores (ATS
Grade) were evaluated before and after therapy. The patients were given
12 treatments, each lasting 30 min.
Results: All patients had improvements in both their O2 saturations and
their ATS dyspnea scores. Mean (SD) SP O2 was 90 (2) %, increasing to 95
(2) % post-therapy. The average dyspnea score of 4.5 decreased to 2.5.
One patient who had been confined to bed for 3 mo with an O2 saturation
of 88% (on 4 l/ min nasal cannula) increased her O2 saturation to 96% on
2 l/ min nasal cannula. Since her therapy, she has been ambulatory with
portable O2. Conclusion: The intensity of dyspnea is clearly related to
conscious perception of the effort involved in breathing. Dyspnea may
arise from the inappropriate relationship between the force of
contraction of respiratory muscles and the volume of air exchange. It is
my belief that this modality realigns this relationship and decreases
the work of breathing. Further studies are warranted.
Case Reports on the Therapeutic Influence of Respiration Feedback (RFB)
According to LEUNER
The 4-year clinical trial of the RFB extended to a random sample of 200
patients suffering from psycho-neurotic, conversion-neurotic and
psychosomatic illnesses, of neuro-vegetative and functional syndromes.
The patients came from the poly-clinics of a medical and a psychiatric
teaching hospital, and thus constituted selected problem cases. A
further group came from a psychiatric practice. The treatment was
conducted by Prof. Leuner's study group at the Psychiatric Clinic of Göttingen
The following text is an account of the statements made by a selection
of successfully treated patients. The treatment consisted of 12 sessions
of 30 minutes each, 3 to 4 sessions per week. (Permanent effects are
considerably improved after 15 sessions, plus an additional 8 sessions
once weekly as a "maintenance dosage"!)
housewife who had suffered from depressive ill-humor and phobias,
declared after the 12th session, "Since I have been undergoing
treatment here I don't cry any more. The stomach pains occur less
frequently, and my sleep is improved. But the most amazing thing is
that I feel more confident. After the 8th session I went shopping
again in a supermarket, without my husband. This was the first time
in 1 1/2 years. Before then I had always been afraid of the
cleaner: she complained of palpitations, states of
anxiety, nausea and general nervousness. The patient had been
depressive for one year, since the sudden accidental death of her
20-year-old son, and was brooding over the "shotgun"
wedding of her 19-year-old son. The patient grew much calmer in the
course of the treatment and said at the end, "I feel like a new
woman." She stated that her symptoms had disappeared
"completely", and that she could view her son's death with
greater detachment now.
theology student, who had suffered from an essential tremor of both
hands for 10 years, summarized the concluding discussions in 3
points: "1) General decrease of nervousness; 2) the impression
to be more at one; 3) since I started the relaxation therapy my
tremor has diminished considerably."
assembly-line worker: she was so nervous that, when treatment first
began, she was hardly capable of spending the whole time lying down
on the couch. She had been suffering from severe back-ache and
insomnia for 10 years. On completion of the therapy she stated,
"Today I would have been able to lie still for much longer; at
the beginning I used to be glad when I could get up after half an
hour. My insomnia has disappeared, and I can go to sleep easily now.
The back-ache occurs less frequently, and no longer every day; the
pain used to last for days, now it is of short duration and no
longer so severe. I have consulted many doctors, and now something
like this has helped me. I can hardly believe it, but it is
Sound Examples (original sounds)