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Treating Eating Disorders With Biofeedback And Neurofeedback: What Does The Science Say?

Wouldn’t it be great if we could just “zap” eating disorders with biofeedback and neurofeedback sessions? Well, within some limits, we can. Here’s what the science says.

Eating disorders are among the most difficult brain disorders to treat. Except for dementia, they have the highest mortality rates. Eating disorders are biologically based conditions that are aggravated by unfortunate personal experiences. No single kind of treatment, whether conventional or alternative, medical or psychotherapeutic, is guaranteed to cure an eating disorder. It takes the full arsenal of treatments and a lot of diligence and support to achieve remission. Biofeedback and neurofeedback are two more tools for reaching recovery.


What is biofeedback and how does it work?
Biofeedback is a method of retraining the body’s responses to food and eating. Some biofeedback methods, like HeartMath, measure variability of heart rate. The user places a finger on a sensor and watches an image of balloon floating over the clouds. If the heart rate is coherent, the balloon floats over the clouds, the heart rate indicates inner calm and emotional self-control. If the heart rate is not coherent, the balloon crashes to the ground and the user is urged to be calm.
Not everyone responds well to being urged to be calm, of course.

There are other biofeedback systems that measure electrical potential of the skin, muscle tension, and breathing rates. When these systems are put through clinical testing, they are usually found helpful in managing certain aspects of eating disorders:

  1. One system helped users regulate pressure in their stomach and esophagus to avoid rumination and regurgitation.
  2. Another system helped users avoid being “stressed out” by their conditions.
  3. A biofeedback method helped its user control food cravings.

It’s usually necessary to try several biofeedback systems to find one that works. They are not prohibitively expensive. Most biofeedback kits for home use cost a few hundred dollars. They do not cause any serious side effects. People who have eating disorders can use them to overcome specific unhealthy habits. They can reduce food cravings. They can blunt uncontrolled urges to eat. Biofeedback can ease anxiety. But it’s not particularly helpful for issues with body image or in relieving depression.

Of all the biofeedback tools for treating eating disorders, HeartMath is the best studied. It's especially successful with teenagers, and especially useful in supporting recovery from anorexia nervosa. Many adolescent users of the technology feel that it shows that they have a "special ability" like those used to master other video games. The popularity of HeartMath declines with age. Computer-averse elders usually become frustrated with the crashing balloon and give up the machine. Some users who have bipolar disorder in addition to an eating issue find the video makes them dizzy.

What is neurofeedback and how does it work?
Neurofeedback is a method of retraining the brain to make it easier to make healthy decisions. Unlike biofeedback, it is based on measuring activity in the brain not the rest of the body. Neurofeedback is based on the recognition that many people who have eating disorders have awareness of their condition They want to make the right choices. They lack the energy to overcome their urges and knowingly harm themselves. They suffer loss of self-esteem by failing to reach their own goals and fall into anxiety and depression.

Promoters of neurofeedback like to point out that the brain consists of about 100 billion neurons with intricate physical, electrical, and chemical connections. These connections can become disordered so that the brain is stimulated when it should be calm and calm when it should be stimulated. In a neurofeedback session, the eating disorders patient is hooked up to an EEG machine and given earbuds to listen to music. Occasionally the music will stop or skip, depending on a computer’s response to changes in the EEG.

That’s the experience for the eatin disorders patient. Go to a calm, quiet place and listen to music for half an hour. Then be better. Can this possibly make a difference in eating disorders?

The truth is, the evidence for this technique isn’t overwhelming. The technology is better for locating the regions of the brain involved in problematic eating behaviors than it is for changing how they work. MRI gives scientists and doctors a good picture of how the brain functions during the “cognitive reappraisal” that causes people to do what they don’t really want to do in anorexia nervosa, binge-eating disorder, bulimia nervosa, and obesity.
EEG is a less precise tool. Neurofeedback has not been developed to the extent that it helps people feel better about their bodies. It doesn’t usually help with body image. It does help in developing in a more functional process of cognitive reappraisal that helps people with eating disorders control their behaviors regarding food and purging.

The bottom line
Biofeedback and neurofeedback aren’t as precise as some other methods of brain-based behavior modification, such as those involving transcutaneous electroneural stimulation (pulsating magnet therapy) and MRI-guided training. But they are beneficial, non-invasive, far less expensive than other brain-based treatments, and free of side effects.