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Patient Story: Virtual Reality Therapy for Fear of Flying

Fright or Flight – A personal story of how one patient used Virtual Reality Therapy to treat his fear of flying.

In an attempt to cope with my fear of flying, I’ve done some ridiculous things. I’ve clutched good-luck charms, swallowed tranquilizers and prayed to the patron saint of air travelers, whoever that is. When I’ve been too anxious to even book a flight, I’ve passed up weekend jaunts to London, endured 16-hour Greyhound rides and traveled from New York to San Francisco by train—round-trip, four days each way. Over the years, my phobia has become a bad joke (though fodder for some good ones among my friends) and a crippling disability.

And so it is that I found myself sitting on a beige La-Z-Boy recliner in a psychologist’s office on the Upper East Side, wearing a virtual-reality helmet, with various wires attached to me monitoring my heart rate, the electrical impulses in my fingers and my breathing. I looked absurd, but I didn’t care. Robert Reiner, Ph.D., founder of Behavioral Associates, a private psychological practice with 20 therapists, told me that this innovative combination of virtual reality and biofeedback—his office is the only one in the Northeast that offers it—could eliminate my terror of hurtling through the air in a metal tube at 500 miles per hour. Good-bye, Port Authority, hello Heathrow!

During my first session, Reiner—an easygoing, confident guy —asked me questions about the origins and development of my fear. (Let’s see, there was that failed journey on a 747 going from Frankfurt to New York, when the engines backfired, the plane dipped wildly to one side, and the pilot announced, “I don’t want to go across the Atlantic on this one.” Not to mention the time I was flying on a ten-seater to Maine through a storm, and we aborted the landing at the last minute because the air-traffic controller was shouting over the radio, “Don’t land! Don’t land! There’s ice on the runway!”) We discussed my counterproductive strategy of “risk avoidance”—I hadn’t flown in three years—and my obsession with the details of major airline disasters (like the Japan Airlines crash, the one where the people on board knew they were going down far enough ahead of time that they wrote their loved ones notes, which were later found in the wreckage).

Reiner didn’t start in on me with safety statistics, which is good, because as far as I’m concerned, they’re meaningless. I am perfectly well aware, thank you, that flying is a million times or whatever less dangerous than driving or taking the train or crossing Fifth Avenue at noon. I know that turbulence is the airborne equivalent of going over a pothole in the road, that pilots are trained professionals and that planes can fly on one engine if the other fails (oh, God). It doesn’t matter. Fear is not rational.

Happily, Reiner didn’t expect me to be rational. “This is not about reasoning and facts,” he reassured me. “This is about a physical reaction to anxiety.” He explained his methodology, which he’s developed over the past year and has used to treat about 100 people, 90 percent of whom have subsequently flown without terror successfully: First, he would take me on a virtual flight to gauge what aspects of it produced the most anxiety; then, with the help of the biofeedback data, I would learn a breathing technique that would synchronize my respiration and heartbeat to produce something called sinus arrhythmia. This technique is what would get me through future sky voyages in one piece, so to speak.

The term sinus arrhythmia practically set off my panic button. But Reiner assured me that being in this (perfectly safe) state makes it “impossible to feel anxiety.” By combining the virtual flight with the breathing over the course of between 5 and 20 therapy sessions (50-minute hours, as with most therapies), he told me that I would condition myself to be able to fly without fear.

For my first simulated flight, Reiner put me in a chair and strapped me into monitoring devices (the same ones used in polygraph tests). Then he put the virtual-reality headgear on me; it was kind of like wearing a motorcycle helmet with a video screen inside. Soon I found myself looking out the window of a plane parked at a gate and awaiting takeoff. The quality of the image was more virtual than reality, similar to a high-end video game. Reiner had already told me that for the therapy to work, I would have to try to convince myself that I was actually flying. So when the engines fired up on the soundtrack (playing inside the helmet), the La-Z-Boy started vibrating, and the captain announced, “Flight attendants, prepare for departure,” I tried to get into the spirit of the thing.

My suspension of disbelief worked. As we sailed up into the virtual sky over a virtual city, then went through a virtual thunderstorm, I felt the familiar signs of panic: tight chest, sweaty palms, leaping heart. When I took the helmet off after landing, Reiner showed me on a large flat-screen monitor what had happened to my vital signs over the course of the flight. Every time something changed—when the engines revved for takeoff, when the pilot announced we were about to enter a storm, when the lightning flashed, when the landing gear descended—my pulse and breathing spiked. No wonder Gary Condit didn’t want to take a bona fide lie-detector test.

In the next session, Reiner worked with me to regulate my breathing, so that I could self-induce this sinus arrhythmia. By taking slow, deep, yogalike breaths, I was able to get my heart line and my respiration line to rise and fall in concert. I have to admit, this produced a very pleasant sensation. I was definitely not fit to operate heavy machinery.

After about eight visits to Reiner’s office, the doc announced that I was ready to fly. This caused a crisis. I had been very proud of my prowess in the sinus arrhythmia department, but on some level, it hadn’t occurred to me that I would actually have to get on a plane. My journalistic principles, however, demanded that I take a nonvirtual flight. The cheapest I could find was a round-trip excursion to Pittsburgh; imagine my delight when I realized I’d be flying AirTran, formerly known as ValuJet (remember that little mishap in the Everglades?).

The morning of truth dawned calm and sunny. I had run out of excuses; there wasn’t even any traffic on the way to the airport. I had nowhere to go but up. And up I went, on a Boeing 717 (good thing I somehow forgot this was the model with the broken jackscrew that caused the Alaska Airlines crash). It was the first time I had flown without chemical support in I don’t know how many years. I breathed slowly and regularly, but quietly, so as not to alarm my fellow passengers.

And then, nothing happened, which was precisely the point. Sure, I had a few little twinges when the plane hit some light turbulence, when the sound of the engines changed and when the pilot made a bit of a hot-dog landing into La Guardia (“Sorry about the aircraft-carrier touchdown, folks. Old habits die hard,” he said with an annoyingly jovial chuckle). But basically, I remained calm and was able to avoid obsessing about my imminent doom. Both the to- and fro-Pittsburgh flights were, as they say, uneventful.

(Originally appeared in Time Out Magazine | Thursday, August 02, 2001)

Helpful Resources:

Research Shows Myndlift is a Powerful Treatment for ADHD

What is Myndlift Home Neurofeedback Training?

Myndlift offers therapist-guided neurofeedback in an affordable, accessible, and safe way from the comfort of your own home. Children, teens and adults are able to treat ADHD and improve their cognitive performance by completing specific trainings on the Myndlift system. These engaging video and game training options reward the brain for optimal performance and overall increase your brain’s ability to regulate itself. The treatment is done using a headset with dry electrodes that sit on the forehead and behind the ears, is non-invasive, and has no side effects. A licensed clinician is able to monitor your training in real-time in order to offer support and make adjustments as you improve. 

Research shows Myndlift is a powerful tool for ADHD

In a recent study, Myndlift utilized their home training program to treat ADHD in children. Each participant, ages 8-15, received home neurofeedback training 3-4 times per week for 9 weeks for an average of 21 sessions per patient. Progress was measured with a Continuous Performance Test (CPT) and parental report.

Overall, children with ADHD that trained with Myndlift had significant increases in attention and reduced impulsivity.

For more research on the link between Myndlift and ADHD, click here.

Myndlift is currently being used in 4 major research studies

Myndlift is currently being used in studies in conjunction with 4 major research institutions around the world for neurofeedback on different populations. While research at Western University in Toronto is focusing on PTSD patients, another study at the Hebrew University of Jerusalem is aimed at treating ADHD in adults. In North America, McMasters University in Toronto is exploring Myndlift for traumatic brain injury, and the Miami Children’s Hospital is conducting a large scale double blind study for ADHD in children. These studies take a long time to gain approval, be carried out, and have the results written and published, but we are looking forward to sharing them as soon as they are available. (Learn more at www.myndlift.com)

Neurofeedback has been used in clinics around the world for decades as an effective and sustainable treatment

Neurofeedback was labeled a Level 1 – Best Support intervention for attention disorders in children (2011). 

The International Society for Neurofeedback and Research (ISNR) is the major organization coordinating the development and research behind neurofeedback. The two links below will lead you to their recommended reading list, as well as their comprehensive research bibliography. Additionally, we recommend the research article “What is Neurofeedback” as a starting point to learn about neurofeedback.

Behavioral Associates leads the way in medication-free treatments for ADHD

At Behavioral Associates, we utilize in-office neurofeedback as well as Myndlift home neurofeedback to help our patients treat ADD / ADHD. Our Children’s Center specializes in diagnosing and treating ADD / ADHD in children and teens. Dr. Robert Reiner, Executive Director, is BCIA Board Certified in both neurofeedback and biofeedback and presents five times annually on neurofeedback to practitioners and graduate level students. If you have a question about neurofeedback or you’re looking to begin treatment, contact us or call the office at (212) 860 – 8500.

Helpful Resources:



AAPB Conference: Free Registration for 4/12 Presentation

Free Workshop Registration Extended to the First TWENTY Students to Respond to this Offer!

Students attending the AAPB Annual Scientific Meeting in Orlando, Florida (April 11-14th) are invited, at the generosity of Dr. Robert Reiner, to attend his 1/2 day workshop at no charge!  He is excited to share his knowledge and experiences on the hot topic of virtual reality and biofeedback and has agreed to pay the registration costs, personally, for 20 lucky students who would benefit from this session.

This offer is extended on a first-come, first-served basis. To take advantage of this offer, you MUST:

  • Email  mcunningham@kellencompany.com directly with your interest. Include in the subject line “FREE WS23”
  • You must be registered to attend the AAPBAnnual Meeting – include your full name, email for verification purposes
  • This offer is applicable to the first 20 students who respond – so do not delay!
  • This special offer is not available online or via our registration methods

About this Workshop

Biofeedback, Virtual Reality and Other Techniques Used to Facilitate the Suppression of Anxiety

Date: Thursday, April 12

Time: 8:00 am to 12:00 pm

Dr. Robert Reiner will provide a history and scientific rationale for the use of virtual reality and other cutting-edge technologies which are now considered a gold standard for anxiety management. The newest technology to catch our attention is home based neurofeedback and how he and his team have integrated it into out-patient care. He will also be showing how  pEMF and tDCS/ACS can be implemented. Following the presentation, attendees will have a broad understanding of available technologies and how and why they have been so successful. He will be joined by Dr. Heather Davidson, the Director of Behavioral Associates Child and Adolescent program, who will be explaining how to use these technologies with children and adolescents.


  • Robert Reiner PhD, BCN, BCB
  • Heather Davidson, PsyD, BCN

Who Should Attend: Mental health professionals and students interested in learning about cutting edge technologies.

Level: Intermediate

CE Credits: 4

*A second workshop will be held on Friday, April 13th from 11:00 AM – 12:30 PM.

About Dr. ReinerDr. Robert Reiner is the Executive Director and founder of Behavioral Associates (BA),   has been practicing psychology since 1981. After receiving his undergraduate degree at the University of Pennsylvania, he earned his PhD in clinical psychology at the University of Alabama and served his clinical internship at Bellevue Hospital/NYU Medical School. He served on the faculty for the Department of Psychiatry at New York University Medical Center from 1980 to 2015 and has been a guest lecturer at the University of Pennsylvania psychology department.  He is frequently seen and quoted in the news and media and is often called upon to make appearances on major news networks. Throughout his career he has served as psychological consultant for several corporations as well as an expert witness in Federal Court for a number of criminal trials.

A Medication Free Approach to ADD / ADHD

What is ADD / ADHD?

Attention-deficit/hyperactivity disorder (ADHD), sometimes called Attention-deficit disorder (ADD), is a neuro-behavioral disorder where there is an ongoing pattern of inattention and/or hyperactivity/impulsivity. ADHD is one of the most common mental disorders among children. The disorder also occurs in adults, both those who had ADHD as children and those who didn’t.

What is ADHD

Our Treatment Approach

At Behavioral Associates, we specialize in a “medication as a last resort” approach to ADD / ADHD.

Our ADD / ADHD specialists utilize a combination of Cognitive Behavioral Therapy (CBT) and Neurofeedback (known as EEG biofeedback) to treat ADD / ADHD without exposing you to the short and long term side effects of medication. Before starting either CBT or neurofeedback, a qEEG Brain scan must be conducted to properly identify the areas of your brain that need improvement. Additional psychological tests may be required depending on the need to comprehensively diagnose and conceptualize the issue. When deemed medically necessary, our staff Psychiatrist is available to provide medication management. Patients may want to avoid medication altogether or work with their psychiatrist to safely and slowly reduce their current medication.


Step 1 – Diagnosis and Understanding the Issue

The qEEG Brain Scan (Brain Mapping)

The qEEG brain scan produces a series of visual maps that are analyzed in order to understand what is happening in the brain, where it is happening and how problematic the issue is. Subsequent brain scans are conducted every 1-2 months alongside CBT and Neurofeedback treatment in order to monitor progress and measure results.

Typical qEEG Brain Profiles

What common symptoms look like in the qEEG brain scan.

Psychological Testing

Further psychological testing may be required in order to provide a balanced and comprehensive summary of you or your child’s needs. This type of testing is often required in order to receive accommodations at work or school, as well as to obtain an Individualized Education Plan (IEP). After completing the initial consultation, your psychologist will have a better understanding of what specific tests should be included.


Step 2 – Creating the Treatment Plan

After the brain scan and further psychological testing (if needed), your licensed clinician will devise an individualized treatment plan that often includes both CBT and Neurofeedback. In the case of children and teens, all work will be supervised by Dr. Heather Davidson, Director of the Children’s Center.

Cognitive Behavioral Therapy (CBT)

Cognitive behavioral therapy (CBT) is a form of talk therapy that is recommended by the CDC as the first line of treatment for ADHD. Behavioral therapy focuses on changing how an individual thinks about a situation in order to change specific patterns of behavior. When used to treat ADHD in children, therapists generally work with both the parent/s and child in order to change behaviors and household norms.

What is CBT?


Neurofeedback, often referred to as EEG biofeedback, is a safe and effective form of brain wave training for patients of all ages. Neurofeedback has been used as a treatment for ADHD in clinics for over 40 years and was identified as a Level 1 Best Support treatment for attention issues by the American Academy of Pediatrics. During neurofeedback training, patients watch a video that rewards the brain for attention, focus and performance. Over time, your brain learns how to take this increased focus and attention and apply it to your daily life. Unlike medication, neurofeedback is not a life treatment for ADD / ADHD.

Neurofeedback picture

Home Neurofeedback Training

While some patients choose to complete their neurofeedback training in the office, there is the option to complete your neurofeedback training at home. Myndlift home neurofeedback training is completed using an Android Tablet and an EEG brainwave headband, which are provided by our office. Each individualized treatment protocol is generated by a Board Certified clinician based on your qEEG brain scan. Your performance and consistency will be monitored in real-time through an online dashboard by your clinician.
Common reasons patients choose home training:

  • Cost-effective: Save money and time by renting a home training unit.
  • See results: Increase your total number of training days and see results quicker.
  • Convenience: Train anywhere with an internet connection.
  • Evidence-based: Neurofeedback identified as Level 1 Best Support for ADHD.
  • 6 training modes: Pick any of six training modes, including games and video.Myndlift neurofeedback training

Next Steps

To learn more about our medication free approach to ADD / ADHD, contact us, call (212) 860 – 8500 or book an initial appointment online.


Helpful Resources:


Author: Brieanna Scolaro, LMSW, Director of Community Relations

Overview: QEEG Brain Map & Neurofeedback

What is a brain map (qEEG)?

A qEEG is a map of the brain that is displayed in a way so that we can easily identify areas of abnormalities.  A qEEG is achieved through a non-invasive recording of EEG brainwaves. It is not painful and only takes about 30 minutes to complete the recording. Through years of medical and psychological research we have developed a database that compares your brain scan results to other’s in the general population that are of similar age and gender. This is how we’re able to see if there is a specific over or underactivity present in the brain. Many different diagnoses present in specific ways, which is why qEEG is a great addition to neuropsychological testing, or a great option when trying to identify exactly what could be going on (for example- is you or your child’s behavior due to organic attention deficits, emotional processing difficulty, anxiety, or depression?)

What is neurofeedback?

Neurofeedback is what follows a qEEG. Once an abnormality has been identified, we can treat this abnormality through brain training instead of (or in addition to) medication. The process of neurofeedback training is completely passive- meaning that you don’t necessarily have to be consciously trying to do anything. It is based off of passive learning and reinforcement. If you’ve ever heard about Pavlov’s dogs (a research study focused on reinforcement where a bell was paired with the dog’s food. After multiple occurrences of pairing the bell and the food, the dogs began to salivate when only the bell was presented even without the food) then you can easily apply this to how neurofeedback works. From the qEEG we develop a specific and individualized training protocol. Each training session you are hooked up to the same cap used to record the brainwaves during the qEEG. This information is fed through a system where you will be reinforced every time your brain is producing more or less of the specific abnormal activity. After so many sessions, the brain learns to naturally produce the normal level of activity and therefore behavior changes, as well (for example- an individualwith ADHD may produce too much activity in their frontal lobes. During neurofeedback training the patient watches a movie that would become larger on the screen if their brain was producing less activity in the frontal lobes and smaller when it was producing too much. After a while the brain learns to produce the ideal amount of activity and your child is able to focus easier).

Are there side effects?

No side effects have been identified from the actual neurofeedback. However some report feeling a bit tired after training as their brain has been working a little harder than normal. A cold glass of water generally solves the problem as hydration is important.

How long does neurofeedback training take?

Research indicates that in order for the brain to learn to the extent where it will not forget, about 20-30 neurofeedback training sessions need to be completed. This can take place once or twice a week for about 20-30 minute periods of time.

I’m interested – Now what?

Contact us or call (212) 860 8500 to schedule the initial consultation. After understanding your background, symptoms and treatment goals, you will be set up with a board certified clinician to complete the qEEG brain scan and begin neurofeedback training.

Recommended Readings: 


Introducing Home Neurofeedback Training

Behavioral Associates is internationally known as a leader in mental health technology combining traditional Cognitive Behavioral Therapy approaches with neurofeedbackbiofeedback and Virtual Reality Therapy. We are proud to be the first practitioners in the metropolitan tri-state area to offer Myndlift, a qEEG-based home neurofeedback training system.

Home neurofeedback training is a safe, medication-free way to treat ADHD, anxiety, depression and more in children, teens and adults. While most of the treatment can be done on the go using the Myndlift system, the treatment protocols are generated by our Board Certified health care providers (Psychologists / Psychiatrists) based on your qEEG brain scan and monitored in real-time through an online dashboard.

Why rent a mobile neurofeedback training system? 

  • Cost-Effective: Save money and time by renting a home training unit.
  • See Results: Increase your total number of training days, allowing you to see quicker results.
  • Convenience: Train anywhere with an internet connection. At home, work or on the go!
  • Family Training: Multiple family members can train on the same device.
  • Evidence-Based: Neurofeedback has been identified as a Level 1 Best Support for ADHD in children.
  • 6 Training Modes: Pick any of six training modes, including games, videos and audio.

To learn more about neurofeedback, check out this presentation: What is neurofeedback? (33 slides)

Why consider neurofeedback over medication? 

Behavioral Associates believes in exploring organic and natural approaches to treating mental and physical health symptoms, when possible, over medication. In the instance of ADHD, doctors often prescribe stimulants such as Adderall or Ritalin. Unfortunately these medications come with unwanted side effects and potential long term consequences. Neurofeedback allows your psychologist or therapist to treat ADHD and other symptoms without using medication as the primary intervention. Some patients may choose to add neurofeedback training alongside their current medication in order to reduce their dependence or completely transition off. For these instances, our staff works  closely with the prescribing Psychiatrist.

What is the process? 

  1. You will first complete a qEEG Brain Scan. This will allow your therapist to understand your brain’s current functioning and create an individualized neurofeedback training protocol.
  2. After your training protocol has been created, you will be set up with a Myndlift home training system (EEG headband, tablet) that is easily accessible via a personal username and password.
  3. Now you are ready to begin your training with support from your therapist at Behavioral Associates.

How do I get started? 

Click the button below to contact us. A representative will reach out to you within 1-2 business days. You can also call the office at (212) 860 – 8500.

Get Started

Watch the videos below for more information about home neurofeedback training.


Upcoming Presentations at the 92Y

Behavioral Associates is proud to announce Dr. Robert Reiner and Dr. Heather Davidson will be featured in two seminars at the 92Y. The discussions aim to shed light on current and pressing topics in mental health, including the latest on depression, anxiety and ADD/ADHD, as well as neurofeedback and Virtual Reality Therapy. We hope you will be able to join us for one or both of these events!

February 12th  – Mental Health 101

Expert psychologists Dr. Robert Reiner and Dr. Heather Davidson of Behavioral Associates share the most common mental health conditions, such as anxiety, depression and ADHD, as well as the top medication free approaches. A series of case studies will be presented to showcase the latest innovations in mental health care, including neurofeedback, qEEG brain scans and Virtual Reality Therapy.

  • Event Details:
    • Date: Monday, February 12, 2018
    • Time: 7:00 PM – 8:30 PM
    • Location: 92nd Street Y, 1395 Lexington Ave, New York, NY 10128
    • Purchase Tickets

April 30th – How Virtual Reality is Revolutionizing Mental Health Care

Dr. Robert Reiner, expert Psychologist and Executive Director of Behavioral Associates, explores how he utilizes Virtual Reality Therapy (VRT) to treat mental health conditions including the fear of flying, public speaking phobia and other forms of anxiety. After outlining the history of VRT, Dr. Reiner will present a series of case studies showing how VRT can be used with children, teens and adults, as well as conduct a live demonstration. Dr. Reiner is one of the nation’s leading experts on VRT and has been featured on major networks including National Geographic, NBC and ABC.

  • Event Details:
    • Date: Monday, April 30, 2018
    • Time: 7:00 PM – 8:30 PM
    • Location: 92nd Street Y, 1395 Lexington Ave, New York, NY 10128
    • Purchase Tickets

If you would like to learn more about Behavioral Associates contact us or call (212) 860 8500.

Dr. Robert Reiner: Seminar Series at the 92nd Street Y

Behavioral Associates is proud to announce Dr. Robert Reiner will be featured in two seminars at the 92Y. The discussions aim to shed light on current and pressing topics in mental health, including internet/gaming addiction and the latest psychological interventions such as neurofeedback and Virtual Reality Therapy. We hope you will be able to join us for one or both of these events!

June 19th – How the Internet and Games are Changing Our Brains

With platforms such as Pokemon Go, Facebook and Instagram sending us notifications every second, we are spending more time than ever in front of screens. This seminar by Dr. Robert Reiner highlights the concept of Internet/gaming addiction and provides a series of case studies that show how our brains are physically changing from overuse.

  • Event Details:
    • Date: Monday, June 19th, 2017
    • Time: 7:00 PM – 8:30 PM
    • Location: 92nd Street Y, 1395 Lexington Ave, New York, NY 10128
    • Purchase Tickets Now

July 10th- Mental Health: The Latest

Expert psychologist Dr. Robert Reiner shares the most common mental health conditions, such as anxiety, depression and ADHD, as well as the top research-based interventions such as neurofeedback, qEEG and Virtual Reality Therapy.

  • Event Details:
    • Date: Monday, July 10th, 2017
    • Time: 7:00 PM – 8:30 PM
    • Location: 92nd Street Y, 1395 Lexington Ave, New York, NY 10128
    • Purchase Tickets Now

If you would like to learn more about Behavioral Associates contact us or call (212) 860 8500.


Overcoming Public Speaking Anxiety: Q&A with Dr. Robert Reiner

A phobia is an irrational fear of an object or experience which triggers an anxiety strong enough to interfere with quality of life and daily activities. In this interview, Dr. Robert ReinerExecutive Director and founder of Behavioral Associates, shares how he treats public speaking phobias with Virtual Reality Therapy (VRT) and biofeedback.

How common is public speaking phobia?

Of all phobias, public speaking is considered the most common, accounting for about 20% of existing phobias. People suffering from public speaking anxiety are often too embarrassed to admit they have a problem and may never seek help. It’s not uncommon for them to have spent their life hiding their fear from family, friends and co-workers which can be extremely isolating.

What makes a person finally confront their fear after years of avoidance?

Often, the person reaches a point in which concealing their phobia becomes a bigger problem than the underlying issue. They may have recently embarked on a new career, furthered their education or reached a point in which the stress of avoidance was unbearable. I had a patient come to me when she found herself in a situation in which refusing to confront her fear was going to result in letting down a family member. The event was her daughter’s wedding, and the bride felt the celebration wouldn’t be complete without a toast from her mother. After about 16 treatment sessions and a lot of practice, she got up in front of 120 guests. To her daughter’s delight and her own relief, the toast was a big hit.

Can you explain how this therapy works?

Cognitive Behavioral Therapy (CBT) has always been combined with a form of exposure therapy in treating phobias. In the past, exposure was accomplished by either putting the person in the actual situation or through imagery. While putting the patient in the situation was impractical, it was even more unreasonable to expect a patient to conjure realistic imagery of something they had spent their entire life trying to avoid.  Virtual reality is a perfect way to expose the patient to the feared object or situation within the safety of the doctor’s office. Combining VRT with biofeedback makes it possible for the patient to learn to control the physiological responses that result in anxiety.

In addition to practicing speeches in front of a virtual audience, how does biofeedback help with public speaking phobia?

Heart rate variability biofeedback teaches the patient breathing patterns that dramatically reduce anxiety. Breathing air into the lungs produces an increase in heart rate, while breathing air out of the lungs results in a decrease in heart rate. Diaphragmatic breathing at a rate of approximately 5-7 breaths per minute causes the largest variability in heart rate in approximately 95% of people.

The breathing rate that produces the biggest drop in heart rate is known as the person’s “sweet spot” and results in a state of total relaxation, incompatible with feelings of anxiety. Once the patient’s “sweet spot” is established, the patient practices the optimal breathing rate for a suggested 20 minutes per day. Although a timer can be used, I have found making patients a recording using the sound of a harmonica for timing breaths in and breaths out to be very helpful.

How often does the patient need to practice breathing along with the Virtual Reality Program?

Generally, sessions will be weekly for 45 minutes to an hour with treatment lasting 12-16 weeks. More recently, and specifically for cases in which time is of consequence, we have been suggesting 6-8 double sessions over about 2 months which has proven to be extremely effective. VRT combined with biofeedback has a success rate exceeding 90%.

Are the results lasting or will the phobia return without continuous treatment?

From the day treatment ends, it’s crucial to get up and practice speaking publicly. The patient needs to confront their fear on a regular basis to avoid falling back into a pattern of protective behavior. This can be accomplished through exercises like making toasts among groups of friends or asking questions at meetings. Once the phobia is resolved through VRT and biofeedback training, practice will yield the greatest long term results.

Is this treatment effective in treating other phobias?

We have had success in treating all sorts of phobias with VRT and biofeedback. For example, Fear of flying is another extremely common phobia that was difficult to treat in the past. Virtual reality now makes it possible for a patient to experience a flight without ever leaving the ground. 

If you are looking to overcome a phobia, Dr. Reiner and his staff at Behavioral Associates have been successfully treating phobic patients with VRT and biofeedback for more than 15 years. If you currently struggle with a fear of public speaking, you’re not alone. Contact us or call our office at (212) 860 8500 to schedule your initial consultation with Dr. Robert Reiner.


Jennifer Pollack, Senior Editor has been writing for Behavioral Associates for more than 10 years.

December 14, 2016

How Biofeedback Cured My Tension Headaches

For as long as I can remember, I have suffered from tension headaches.  As a student, they would come on fast and furious while preparing for an exam and later in life before a presentation at work. You could bet on a real “throbber” during life’s difficult times, like transitions, break-ups or when my father became ill. As if these already stress inducing events weren’t bad enough without the pain associated with a tension headache. But this is the nature of the ailment, it gets you when you’re most vulnerable.

Now I realize all the ibuprofen I took may have done more harm than good given my “weak” stomach. Although it has since been determined that my nerves were also a big factor in my stomach discomfort, it was seeking reprieve from the headaches that brought me to biofeedback therapy. Ironically, the biofeedback I learned for my headaches has also helped with my stomach woes.

After years of riding the storms, I finally decided the pain was too much to endure. As I got older the headaches became longer lived, more painful and more frequent. I even began to spend time worrying when the throbbing pain would turn my world upside down which only fueled the problem. After many unsuccessful attempts with pain killers and anti-inflammatory medications, both over-the-counter and prescription, I decided it was time to pursue a natural remedy. I heard Cognitive Behavioral Therapy (CBT) was effective in reducing anxiety and managing pain. I knew myself well enough to say confidently that the headaches were the worst when my stress levels were at their highest.

My therapist suggested a combination of CBT and biofeedback as the best treatment plan for my condition. He explained to me that biofeedback combats stress by teaching relaxation techniques. It is possible to consciously manipulate breathing, heart rate and other usually involuntary functions to override your body’s response to stressful situations. At first I was skeptical. I wanted to believe but the concept was difficult to grasp after years of suffering. How could this finally relieve my pain?

I found out that biofeedback works by attaching sensors to the body to measure key bodily functions including breathing, muscle tension, heart-rate, blood pressure, peripheral skin temperature and EEG brain waves. I was going to learn to gain control over the muscle tension that was causing the headaches.

Specifically, for tension headaches like mine, biofeedback can be extremely effective, as the headaches are a result of keeping muscles in the head area in a tense state, especially in situations of high stress. I was totally unaware of this response but it made sense when I could view my muscles contracting on the computer monitor. Being able to visualize what was going on took away some of my doubt. It made sense to me that tense muscles could contribute to a tension headache. This was the point I agreed to start my journey in biofeedback.

In preparation, several sensors were attached to my forehead, so that tension in the muscles of my head, jaw and neck could be recorded through the electrodes. This muscular tension was then converted into a tone and any increase in the muscular tension resulted in a corresponding increase in the tone. Consequently, as the tension went up, the tone got louder, and as the tension went down the tone became softer. This made it so I could understand the variations in muscle tension.

Then my doctor instructed me to reduce the tone in any way possible, which would correspond to a reduction in the tension in this area. Initially this seemed like an impossible feat, outside of my realm of comprehension, but with encouragement and by a process of trial and error, I learned to relax my jaw, forehead, and neck, which reduced the tone and in turn reduced my tension headaches. After practicing with the biofeedback system for about a half a dozen sessions, I was slowly weaned away from the machine. After several more sessions I learned to respond to my internal signals of relaxation rather than relying on the external signals from the machine.

Outside of the office, I became aware of facial tension in my everyday life which allowed me to relax in previously tension-producing situations. Although I am not 100% free from tension headaches, they are far more infrequent and I have learned to recognize when they are coming. This allows me to practice the exercises I learned on the biofeedback machine at the onset of a headache.

I believe what I gained during biofeedback therapy 3 years ago will be a permanent part of my psychological make-up. I am now able to face stressful situations without the debilitating fear and dread that controlled my existence for so much of my life. I still go back to my therapist periodically to brush up on relaxation skills but for the most part I can say that I have been cured.

Jennifer Pollack, Senior Editor has been writing for Behavioral Associates for more than 10 years.

November 4, 2016

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