Earlier in this book, I made reference to the biofeedback of other autonomic nervous system modalities including muscle tension, thermal (peripheral blood flow), electrodermal activity, and heart rate variability (HRV). These peripheral biofeedback treatments are often used prior to doing neurotherapy for the purpose of quieting and relaxing the client.

There are some conditions in which the treatment of choice is not neurotherapy but rather biofeedback of a peripheral modality. Tension headache is a good example of a condition that may respond more rapidly and efficiently to muscle (electromyographic) biofeedback than to brain wave biofeedback. Likewise, the treatment of migraine headache may respond more efficiently to peripheral blood flow training.

There are also some conditions that respond most favorably to a combination of both central and peripheral biofeedback, both sequentially and simultaneously. For example, HRV training has been shown to increase the amplitude of the sensory motor rhythm (13–15 Hz; SMR) (Reid and Nihon 2011; Reid et al. 2013). Thompson and Thompson (2011) report that simultaneous neurofeedback training to increase SMR amplitude over the sensory motor cortex (location Cz) combined with HRV training was very effective for the treatment of a client with advanced Parkinson’s disease. Other peripheral biofeedback modalities were also used with this client to facilitate relaxation and concentration.

In the following paragraphs, I introduce some of these modalities for the practitioner. The following is limited to a basic introduction and description of biofeedback procedures of the autonomic system. It does not provide details adequate for a practitioner to learn these techniques. The interested clinician should read the definitive text in the area of biofeedback for the autonomic system by Schwartz and Andrasik (2005). Biofeedback texts, training manuals, and tutorial videos are available on the Association for Applied Psychophysiology and Biofeedback web store at www.​aapb.​org.

Electromyographic (EMG) biofeedback provides information on the tension of the muscles. The tension level of a particular muscle group, as measured by the electrical activity, can be fed back directly to the client. The direct feedback helps the client learn how to relax the muscle tension. EMG biofeedback is valuable in the treatment of motor disorders with clients who have traumatic brain injury, such as a stroke. It also eases muscle pain problems, including lower back pain and headaches. Neurotherapists also frequently use EMG feedback of the muscles of the forehead as a general relaxation treatment.

Gruber and Taub (1998) showed that animal subjects could control various physiological systems. In one study they report that adult male monkeys could reduce muscle tension in the forearm of the dominant arm by an average of 50 % over a ten-session training period.

The following is the case of a client who was more effectively treated with peripheral biofeedback rather than with neurotherapy. The client, a male in his 40s, had been hospitalized because he was suicidal and depressed. For the past 5 years, he had suffered from a condition that started as a persistent headache and subsequently was experienced as a feeling of pressure and profound cognitive “fuzziness.” He was in continuous discomfort, could not think properly, and had lost his job. He became increasingly withdrawn from friends and family and experienced frequent and intense episodes of depression with strong suicidal fantasies.

Numerous diagnostic tests had failed to identify the cause of his problem, so he was referred to me to determine if neurotherapy might help. The various brain scan procedures that he had received did not show anything extraordinary, so I decided to do some measurements of the peripheral system because the symptoms suggested that the peripheral autonomic nervous system, rather than the central nervous system, should be examined. The peripheral systems included the muscles, vascular system, heart functions, skin response, and breathing. The client’s muscle tension, peripheral blood flow (as measured by skin surface temperature), electrodermal response, heart rate, and breathing were measured both at rest and when he was exposed to a minor stressor. The stressor that I generally use is backward serial sevens in which the client counts backward by sevens from some arbitrary number such as 713. The counting is done out loud. This procedure increases the heart rate, blood pressure, and other indicators of peripheral arousal.

The assessment provides a lot of information about the client’s autonomic nervous system’s level of arousal. At rest, the forehead muscle tension was 7.8 μV, and it increased to 12.8 μV when counting backward. The tension in the forehead should be around 2 μV and, when the client is counting, the increase should be in the range of 1.5 μV. The client’s other autonomic systems indicated normal levels and normal reactions to stress.

It seemed likely that the problem was caused by excessive tension in the muscles of the head. To test this assumption, I had the client do muscle biofeedback of the muscles in the head and also in the muscles of his upper torso. The client was able to substantially reduce the muscle tension in his forehead in a short time. As the muscle tension decreased, skin conductance increased remarkably. Electrodermal activity responds to emotional feelings and in this case it occurred when he started to cry. I asked him about his crying, and he told me, “The pressure in my head is gone.”