Foundations of Treatment 115Biofeedback
A technique by which a person is trained to
bring normally involuntary or unconscious
bodily activity, such as heart rate or muscle
tension, under voluntary control.1998; Hoffman et al., 2005). Additional studies are needed to confi rm these ex-
perimental results and determine the optimal location of the coil, as well as the
frequency and strength of the pulses, for treating each disorder.
TMS offers several advantages over ECT: It produces minimal side effects and
is easier to administer (no anesthesia or hospitalization is needed). In fact, the most
commonly reported short-term side effect, a slight headache, affects only about
5–20% of those receiving TMS.
Although ECT and TMS can provide relief for some disorders, these direct
methods of brain stimulation are generally used only when other types of treatment
have been unsuccessful.Biofeedback
Biofeedback is a technique by which a person is
trained to bring normally involuntary or uncon-
scious bodily activity, such as heart rate or muscle
tension, under voluntary control. It works as fol-
lows: Electrical leads are placed on the body in
the appropriate locations to measure the targeted
biological activity (such as pulse rate or muscle ten-
sion level), and the patient can see the activity (dis-
played on a graph or as a sequence of fl ashing lights)
or hear it (in the form of musical tones or beeps
transmitted through headphones or a speaker). At
fi rst, patients can only slightly affect the biological
activity, but over time—largely by a process of trial-
and-error—each patient discovers his or her own
way to induce the desired change. When the per-
son does something that produces a desired change,
this feedback serves as a positive reinforcer—which
makes it more likely that the person will repeat that
behavior to produce that change in the future. With
training, a patient eventually can learn to keep the
targeted biological activity within the desired range (Blanchard, 2000). Biofeedback
is used to treat involuntary muscle tension associated with some anxiety disorders
and some sexual disorders (Chapters 7 and 11; Reiner, 2008).Changing Brain Structure Through Neurosurgery
Neurosurgery—brain surgery—is used only rarely to treat people with symptoms
of psychological disorders. It is a treatment of last resort, used when all other treat-
ments have failed and the disorder is suffi ciently severe that it prevents even a sem-
blance of normal life (Davidovsky, Fleta, & Moreno, 2007; Morgan & Crisp, 2000;
Price et al., 2001). During neurosurgery, either specifi c brain structures are destroyed
or their connections with other parts of the brains are severed, thereby changing
brain functioning; these changes in brain functioning in turn reduce the intensity or
frequency of the symptoms. For example, neurosurgery can be a last resort treat-
ment for obsessive-compulsive disorder (OCD), a disorder in which individuals
are extremely preoccupied with performing mental rituals, such as counting to
100 after having a self-defi ned “bad thought,” or physical rituals, such as repeat-
edly going back to check that the door is locked after leaving home. Such rituals
can be repeated for hours at a time. For patients with extremely severe symptoms
of OCD, when all else has failed, neurosurgery may be used to destroy a small
part of the anterior cingulate cortex. This procedure can disrupt the brain cir-
cuit that keeps patients engaged in their mental or physical ritual (Jenike, Baer, &
Minichiello, 1998).Biofeedback is designed to allow patients to
control biological activity that is normally
involuntary. Successful use of biofeedback draws
on learning principles. This woman is learning
to identify and decrease muscle tension.Will & Deni McIntyre/Photo Researchers