Psychotherapy (therapy of the soul) is the basic building block for all forms of psychological processes that aim to treat psychosomatic illnesses, trauma or behavioural dysfunctions without medication.

From the perspective of the science of psychology or psychotherapy research, psychotherapy is a special kind of a controlled human relationship, with a scientific background, in which the therapist creates the special conditions and circumstances to make possible, for one or more of the people being treated, changes aimed at curing or limiting mental/physical problems.

To do this, scientifically proven methods of explicit/verbal and non-verbal communication are systematically used. There are various forms/schools with recognised methods and some are specialised in specific mental health problems. This makes it often difficult for the person concerned to choose the appropriate treatment, without knowing which method is the most appropriate for his/her case.

Personal development can also be associated with psychotherapy or even be an exclusive goal. The quality and shaping of the relationship and the motivation of the therapist by the therapist increase the ability of the client to manage his/her problems and gain increased mental and physical well-being.

Biofeedback therapy should only be applied by properly trained specialists. Abroad the title and application of biofeedback therapy is protected and applied only by persons trained by an official biofeedback company. These and only these individuals are entitled to bear the title of biofeedback therapist. In short, the title of biofeedback therapist and the practice of biofeedback therapy shall be held and applied only by medical doctors, psychologists trained in psychotherapy and/or clinical psychology, following a protocol of training by the respective official biofeedback company. The training varies depending on the company and the level of difficulty in obtaining the biofeedback therapist certification. The Austrian and German biofeedback and psychophysiology societies have a 150-hour training protocol with 10 hours of supervised application of therapy, as well as a mandatory one-case treatment presentation paper.

Individuals who are not physicians or psychologists trained in clinical psychology or psychotherapy do not hold either a title or practice biofeedback therapy. However, they can be trained as biofeedback coaches with fewer hours of training but definitely 10 hours of supervision and a final assignment.

The training protocol provided by such companies ensures expertise and appropriateness in the application of treatment to patients. In Greece, unfortunately, as a specific sector, it is unfortunately not protected and not registered. However, the person seeking biofeedback therapy can and should ask the referring therapist to inform him/her about the level of training he/she has in this field. So it will be a matter of judgement.

As far as biofeedback devices are concerned, a complex device can certainly show more psychophysiological variables or even impress. However, the best tool is of no use in the hands of an inadequately and insufficiently trained individual. Treatment protocols are taught by the appropriate certified and official agencies. The device does not make the therapist!!!

Tension-type headaches are generally caused by the continuous muscle contraction in the trapezius, neck and cervical muscles, as well as in the muscle groups of the face. Psychosomatic, mental factors and stress can also be causes of their development. Another possible cause is improper posture of the neck and spine.

With biofeedback therapy the person can consciously learn to control the muscle tension of the muscles associated with the sensation of pain and through repetition this can be assimilated as a skill. The individual also learns the psychophysiological parameters that occur during tension-type headache, resulting in a reduction in most of the time. In the case where the incorrect posture is responsible, the person is trained, always using a biofeedback multidevice, to hold the body correctly, coordinating the muscle tension appropriately, which will be indicated by the trained biofeedback therapist.

Over time and with the development of the above skill the cause of the muscle tension will be regulated and therefore the consequence of the tension, which is pain, will be eliminated. The duration varies according to protocol between 10 and 20 sessions, although this is not always an absolute value.

(As is always the case in dysfunctions with physical symptoms, an appropriate examination and assessment by a doctor of the relevant specialty is necessary).

Clinical psychotherapy/hypnotherapy is one of the most prevalent forms of psychotherapy worldwide. Its main characteristic in comparison to other forms of psychotherapy is that the psychotherapeutic process takes place in the subconscious of the patient. It is therefore therapy that takes place “in a subliminal state”, in a different state of consciousness. The term hypnosis, as originally formulated, because of the earlier view that the therapist is in a deep sleep, is now considered obsolete and anachronistic. However, it has prevailed and is still used to this day. We could descriptively describe hypnosis as the focused attention within the self and its internal processes, i.e. attention directed to the subconscious. In contrast to the conscious mind, which can be described as the “procedural mind”, i.e. the part of the self that is concerned with practical matters and logical/rational processes. The subconscious mind functions in a holistic form, with symbols, but mostly emotionally.

By emotion we mean the biological substance of emotions, the seat of which is known to be the amygdala of the brain. Hypnotherapy in hypnosis aims to reframe unpleasant emotions and to free the patient from the continuous incomplete cycle of experiencing these emotions. This psychotherapeutic process is called in hypnotherapy terminology subliminal therapy. Its cornerstone is the so-called emotional reframing, i.e. the release of unpleasant emotions and a deeper awareness that they belong to the past. Through this will come the elimination of the consequences of repressed subconscious emotions. Any form of hypnotherapy has to achieve emotional reframing in order to be able to claim that it has actually achieved a therapeutic effect.

Hypnosis in itself is simply a form of the state of consciousness of the individual, as described above. Since there is no hypnosis but only self-hypnosis, we are in fact talking about a physical state which anyone can enter. When we speak of hypnosis, we are not referring to any form of psychotherapy, but only to the state. The well-known hypnotic submissions, as impressive as they may be, are in no way a form of treatment. On the contrary, due to the hypnotic state, the individual, more because of the fact that the rationality factor has been bypassed, accepts for some time the messages presented subliminally. Something similar happens with advertisements where there are submissions that are not made conscious by the conscious mind but only by the subconscious. The purpose of any form of psychotherapy is to identify the traumatic experience and to reframe or reconstruct it.

If this building block is missing then it is not a cure. Hypnotic submissions find fertile ground for some time, but most of the time the symptoms that are eliminated return with greater severity. For this reason, in a responsible form of treatment, submissions are combined with subliminal therapy, although once the latter is successfully completed, submissions are usually not necessary.

So, there should therefore be no confusion between the term hypnosis and the term hypnotherapy or clinical psychotherapy/hypnotherapy, which is the full term.

In the first case we are not talking about a form of psychotherapy.

Panic attacks are characterised by intense symptoms experienced by the person and are extremely disturbing. This phobic reaction manifests itself intensely in the body and brings about a series of psychophysiological changes during the time that the panic attack occurs.

Biofeedback therapy can clearly help the individual to control and reduce or even eliminate these symptoms, through conscious observation and conscious control of psychophysiological parameters responsible for the occurrence of symptoms. Through (specific) techniques learned by the patient from the biofeedback therapist, the patient ultimately achieves the above control. Representing the psychophysiological variables of the patient in a visual/auditory way helps the patient to understand their nature as well as to control their course all the time at all times. 

It is of course important to diagnose whether there is also agoraphobia, which is usually the case, which also needs to be treated. Then the therapeutic process must be completed psychotherapeutically. However, biofeedback therapy is extremely appropriate and effective, provided that a specific psychophysiological differentiation has been identified in the panic attack and there is a corresponding specific therapeutic technique to relieve the person of the characteristic tendency to faint and dizziness and the high number of pulsations.

 As is always the case with dysfunctions with physical symptoms, an appropriate examination and assessment by a doctor of the relevant specialty is necessary.

Any form of biofeedback is useful and can be used by the specialist. In distraction or even in attention problems, the purpose of biofeedback is to increase the brain activity of parts of the brain involved in mental activity. In this way, mental performance will also increase. For example, a track and field athlete who wants to increase his speed performance will exercise his legs so that they can increase strength and speed at the same time.

There are physiological variables that can be influenced mentally, at will, and increase the ability to focus attention, which results in better mental performance. The best-known form of biofeedback, until recent years, has been neurofeedback of the electroencephalograph also known as EEG. It recognizes brain activity through brain electrical waves. However, its application in practice is very difficult because the precise placement of electrodes takes a long time and the number of electrodes is great. Also, the measurements taken by the electroencephalograph are very sensitive to movements that the patient may make, which cannot be avoided, so the specialist has to filter in the graph the actual measurements and those from movements. EEG also measures surface activity of the cerebral cortex (postsynaptic potentials) and the control of these activities is more subconscious than conscious. Clearly it is a very good tool but one that has practical problems in application and makes it quite difficult for both therapist and patient.

 The new form of HEG neurofeedback, the so-called hematoencephalograph, is gaining more and more supporters as it is the solution to the problems that the electroencephalograph had. It is very easy to apply since the sensor is easily placed in the forehead area. According to the leading neuroanatomist Walle, the frontal cortex is the most important meeting point between the sensory area and the limbic nervous system. It is the point associated with personal emotions, motivation and subjective knowledge. Because of its strategic anatomical location, the frontal cortex is the largest system of human emotional behaviour.

In the HEG hematoencephalograph, brain activity is measured through oxygen supply modulation. Cognitive processes stimulate neurons in specific parts of the brain. These consume energy which leads to a local increase in blood flow. Neurofeedback with the hematoencephalograph makes it possible to increase blood flow to selected parts of the brain.

This special feature of HEG makes it the most suitable tool for increasing the ability to focus attention, thus helping to cope with distraction. The person can consciously during the session activate the offending brain points and greatly improve his attention or concentration problem. Research documenting the superiority of hematoencephalography in neurofeedback is growing.

But beyond neurofeedback, one can be helped with concentration and attention problems through electro-dermal biofeedback and appropriate psychoeducational software. Of course, the specialist should have expertise and experience in assessing the graph of electrodermal activity and should always be able to explain the course of the graph curve. In this case and this kind of biofeedback is excellent and can help.

Besides, there is no therapeutic intervention that is as apt and effective in the problem of distraction and increasing mental performance.