The Institute of Living, Hartford, CT, USA.
Yale University School of Medicine, New Haven, CT, USA.
Adv Exp Med Biol. 2020;1191:265-289. doi: 10.1007/978-981-32-9705-0_16.
Biofeedback refers to the operant training of physiological responding. Variants include electromyography (EMG), electrodermal activity (EDA), skin temperature, heart rate (HR) and heart rate variability (HRV), respiratory biofeedback of end-tidal CO (ETCO), electroencephalography (EEG) signal, and blood oxygen-level dependent signal using functional magnetic resonance imaging (fMRI). This chapter presents a qualitative and quantitative systematic review of randomized controlled trials of biofeedback for anxiety disorders as defined by the 3rd through 5th editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM). Meta-analytic results indicated that biofeedback (broadly defined) is superior to wait list, but has not been shown to be superior to active treatment conditions or to conditions in which patients are trained to change their physiological responding in a countertherapeutic direction. Thus, although biofeedback appears generally efficacious for anxiety disorders, the specific effects of biofeedback cannot be distinguished from nonspecific effects of treatment. Further, significant limitations were identified in the existing literature, with the majority receiving a "weak" rating according to Effective Public Health Practice Project (EPHPP) rating system guidelines. Future directions for research are discussed.
生物反馈是指对生理反应进行操作性训练。其变体包括肌电图（EMG）、皮肤电活动（EDA）、皮肤温度、心率（HR）和心率变异性（HRV）、呼吸末二氧化碳（ETCO）的呼吸生物反馈、脑电图（EEG）信号以及使用功能磁共振成像（fMRI）的血氧水平依赖性信号。
本章对第 3 至第 5 版《精神障碍诊断与统计手册》（DSM）定义的焦虑障碍的生物反馈随机对照试验进行了定性和定量系统评价。元分析结果表明，生物反馈（广义定义）优于候补名单，但尚未显示优于积极治疗条件或患者接受培训以改变其生理反应的反治疗方向的条件。因此，尽管生物反馈似乎对焦虑症普遍有效，但生物反馈的具体效果无法与治疗的非特异性效果区分开来。
此外，在现有文献中发现了重大的局限性，其中大多数根据有效公共卫生实践项目（EPHPP）评级系统指南被评为“弱”。讨论了未来的研究方向。
