Biofeedback/Neurofeedback — What are Biofeedback and Neurofeedback?


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Biofeedback and neurofeedback are treatment methods and specialties practiced by specifically trained individuals who come from one or more health professional disciplines or backgrounds. Biofeedback teaches people to alter brain activity, blood pressure, muscle tension, heart rate and other bodily functions that are not
normally controlled voluntarily. Biofeedback is a training technique in which people are taught to improve their health and performance by using signals from their ownbodies.

Biofeedback clinicians often were trained initially as clinical psychologists, physicians, psychiatric social workers, dentists, physical therapists, counselors, or in some other health care profession or discipline. Qualified biofeedback providers have acquired the necessary knowledge, training, skills and experience to utilize these non-invasive, non-pharmacologic treatment methods. These forms of treatment have proven to be safe and beneficial for many health problems and conditions which often have not responded well to conventional medication based treatment.

In the following two sections, we discuss biofeedback and neurofeedback in more detail.


What is Biofeedback?
How does it work?

The word "biofeedback" was coined in late 1969 to describe laboratory procedures that were developed in the 1940’s, which trained research subjects to alter brain activity, blood pressure, muscle tension, heart rate and other bodily functions that cannot normally be controlled voluntarily. Biofeedback is a training and treatment technique in which people are taught to improve their personal health and performance through detecting, monitoring, training and using this information going on in their own bodies.

Clinical psychophysiologists (more familiarly known as biofeedback therapists) use sensitive electronic instruments, within a therapeutic relationship, to measure, amplify and provide feedback on physiological responses going on within the human body. It is scientifically well accepted that stress, environmental events, thoughts and emotions all influence our ongoing patterns of physiological response and may result in uncomfortable symptoms and illness.

Most persons tend to be unaware of the subtle ways in which minds and bodies interact. It is, however, possible to detect, observe and modify maladaptive patterns of interactions between these two domains. Under the guidance of a trained and qualified practitioner, and using specialized electronic biofeedback instruments that can monitor internal physiology in real time, individuals can be taught and learn to apply self regulation skills to both influence and modify the their bodily and psychological  responses to events going on in their life in more healthful and efficient ways.

One commonly used biofeedback device, an electromyograph or EMG, for example, picks up electrical signals from the muscles. It translates these signals into forms that people can both see and hear. The EMG displays lights or activates sounds, tones or music every time muscles become more tense, and these sounds and the visual information changes in understandable patterns when muscles relax. If one wants to relax tense muscles, one learns through practice, to slow down the change in the color of a light show on a visual display or alter the tones heard through earphones or a loudspeaker. People soon learn to associate sensations from their muscles with actual levels of tension in them and develop new, healthier habits of keeping muscles only as tense as is necessary, and only for as long as necessary.

In the case of muscle spasm, pain quickly diminishes and disappears as muscles relax. After treatment, individuals are then trained to repeat this relaxation response voluntarily and at will without being in the treatment facility or being attached to the sensors or the biofeedback equipment. Scientists call this phenomenon “generalization.” As is the case in learning a successful and accurate golf swing, these skills require repeated sessions until well learned.

Other biological functions commonly measured and used in biofeedback to help people learn to control their physical functioning and symptoms are skin temperature (thermal biofeedback), heart rate, sweat gland activity (GSR, SCL or EDR biofeedback) and brain wave activity (EEG biofeedback or neurofeedback). A very recent addition to biofeedback treatment technology is heart rate variability (HRV) training of use in certain cardiovascular problems. 

Biofeedback clinicians utilize complex computer assisted biofeedback equipment, specialized purpose built software, video displays and auditory signals much as you rely on a bathroom scale to tell you how you are doing with your diet, or the way you use a  thermometer to feed back whether your medication is controlling your fever. In a more complex manner, electronic biofeedback equipment detects internal bodily states and functions with far greater sensitivity and precision than is possible without such equipment. Both patients and therapists use the information produced by the instrumentation to direct and gauge progress in treatment, and to learn and relearn health inducing and symptom reducing modes of functioning.

Dozens of studies have shown we have more control over many involuntary bodily functions than was once thought possible. As a result, biofeedback has become a means, resource and method for training individuals in techniques for reducing stress and for living a healthier life overall, whether one is afflicted with a medical condition and associated symptoms or not.

What Kinds of Health Problems Can Biofeedback Help?

Physicians, psychologists, physical therapists, nurses, clinicians, social workers and researchers who have been specifically trained and experienced in the clinical use of biofeedback utilize biofeedback equipment and special training to assist individual patients in the treatment of stress related illnesses and disorders, in rehabilitation, with neurological processing disorders and in developing athletic and peak performance skills in both sports and occupational activities. Equipment alone does not do the training, but a combination of equipment and the training methods used by the qualified therapist in "coaching" the patient or client to use the information fed back, and to transfer that training to everyday life, constitutes the regimen that is used to reduce or eliminate symptoms, promote healthy functioning and, very often, to reduce or eliminate the need for medication or other supports. 

Stress related disorders effectively treated with biofeedback include conditions such as headaches, high blood pressure (hypertension), anxiety disorders, diabetes, irritable bowel syndrome, motion sickness, chronic pain, myofascial pain, jaw pain, reduced peripheral blood flow (Raynaud's disease) and insomnia, to name a few. Biofeedback may be used alone or in combination with medication. It is not an either/or treatment. A number of patients using biofeedback seek out this form of treatment because they are allergic to, intolerant of or have adverse side effects from medications often used to treat their conditions. When administered by competent and experienced clinicians, there are no adverse physical side effects associated with biofeedback.

Clinical research and application of findings from many controlled studies have demonstrated biofeedback techniques to be safe, efficacious, non pharmacological, non-invasive procedures that are now widely used procedures to treat an ever lengthening list of conditions. A partial list of conditions that benefit from biofeedback includes:  

    •  Migraine headaches
    •  Tension headache
    •  Other types of chronic pain
    •  High blood pressure
    •  Anxiety and panic disorders
    •  Sleep disorders
    •  ADD (Attention Deficit Disorder)
    •  ADHD (Attention Deficit Hyperactive Disorder)
    •  OCD (obsessive compulsive disorders)
    •  Disorders of the digestive system
    •  Fecal and urinary Incontinence
    •  Cardiac arrhythmias (abnormalities in the rhythm of the heartbeat)
    •  Raynaud's disease (a circulatory disorder that causes uncomfortably cold hands)
    •  Epilepsy
    •  Paralysis, spinal cord injury and a number of movement disorders
    •  Traumatic brain injury sequelae
    •  Stress-related disorders and stress management
A number of other conditions in which reduction of autonomic arousal and stress lead to reduction in symptom levels, less discomfort and reduction of need for elevated dosage of medications that cause unpleasant and not well tolerated side effects benefit from biofeedback treatment as an adjunct to pharmacologic or medicine based therapies. It is not uncommon for patients to utilize both medication and biofeedback to control or reduce symptoms. In many cases, cure is not possible, but better management of the illness is a possibility, and biofeedback used alone or in combination with medication, or alone in all of the above listed conditions is almost invariably helpful.

There are a number of health conditions not listed above in which biofeedback has proven efficacious. These applications are sometimes empirical (or experiential) rather than a research evidence-based application. Conditions such as fibromyalgia and chronic fatigue syndrome often benefit from biofeedback.

Evidence That Biofeedback Works

Biofeedback has proven to be an effective treatment for migraine and tension headaches in both children and adults. Effectiveness of biofeedback has been proven by numerous controlled studies, some with follow-ups of patients up to 15 years post treatment. The American Association for Headache cites biofeedback as an acceptable treatment.

Eighty percent of individuals with essential hypertension who underwent biofeedback training in one study were able to safely reduce their prescription medication dosages, or no longer needed them at all, even after years of taking medication. Many anti-hypertensive medications unfortunately have uncomfortable side effects. Dosage reduction may be a goal of such treatment rather than elimination of a medication.

Numerous studies have shown that people with panic and anxiety disorders who undertake biofeedback training will gain significantly in their ability to control these states, to the point that these no longer interfere with their daily life.

More than 700 groups worldwide are now using EEG biofeedback (neurofeedback) for treatment of ADD/ADHD (Attention Deficit Disorder and Attention Deficit Hyperactivity Disorder). This condition impedes learning and the classroom performance of many children in our society today. Clinicians report that patients experience a 60 to 80 percent significant improvement in the condition, and usually a marked reduction in medication requirements. A marked reduction in medication side effects often accompanies reduced dosage requirements. Many ADD and ADHD patients improve sufficiently that they no longer require medication.

The Agency for Health Care Policy and Research Consensus cites biofeedback as a primary treatment for urinary incontinence, a condition affecting up to 30 percent of elderly people living independently, and as many as 50 percent of patients in long term care facilities. Illnesses such as multiple sclerosis, muscular dystrophy or lupus, as well as strokes and prostrate surgery, also may cause incontinence.

In more than 90 percent of children under the age of twelve with sleeping problems such as bedwetting, recovery is expected within the first two months of biofeedback treatment.

Peak performance training in which biofeedback is the training modality is increasingly being used in business as well as in sports medicine. Dr. Lester Fehmi, Director of the Princeton Biofeedback Centre, for example, has consulted to the Dallas Cowboys (NFL) for stress management and to enhance player performance.

Studies on women with PMS have shown biofeedback can help relieve these symptoms.

Physical therapists and physiatrists (physical medicine and rehabilitation specialists) in several states, including Florida, Wisconsin and New Jersey, have found that some spinal cord injury and chronic neuromuscular disease paralysis victims have been able to regain most of their muscular limb abilities after biofeedback training. This dramatic approach is not yet readily available in many states, however. The results, though they sometimes appear to be miracles (i.e., helping people told they will never walk or use their hands again to walk or feed themselves), are really only the results of the practical use of existing biofeedback technologies.

Stress related disorders are highly prevalent in our fast paced, fast moving, stress inducing society. Stress related disorders are numerous and of many kinds. There are very few stress related disorders in which clinical biofeedback is not of help. Biofeedback clinicians are specially trained and take especial interest in stress modification and stress management, and employ many kinds of interventions and techniques in helping clients and patients modify and manage stress in their lives. Not all stress reducing modalities and interventions involve biofeedback equipment. Many biofeedback clinicians have extensive training and experience as counselors and psychotherapists and are licensed to practice as such.

Biofeedback techniques adapted for sports training and work site interventions now provide athletes and other workers with the ability to refine their skills and improve their efficiency and body mechanics. Olympic class USA and foreign athletes for many years have used biofeedback as part of their training for high level competition both to improve and enhance their individual performance. It has become almost routine for top athletes in many sports to receive biofeedback training to increase their edge.

More Information about Biofeedback:

Click here for an in-depth article on the efficacy of Biofeedback.


What is Neurofeedback?
How does it work?

Neurofeedback, also known as neurotherapy or EEG Biofeedback, is a biofeedback technique that monitors and modifies brain wave patterns. It is different from “traditional” biofeedback, which measures physiological systems. It has been found effective in treatment of epilepsy, attention deficit disorder (ADD), attention deficit hyperactivity disorder (ADHD) and has been found helpful in treating obsessive compulsive disorders (OCD), as well as addictive behaviors such as alcoholism. It can often be helpful in rehabilitation of traumatic brain injury, as well. Neurofeedback also shows promise as a treatment for a number of additional disorders, and research is ongoing. A combination of biofeedback and neurofeedback has, in many cases, been effective in neuromuscular re-education and rehabilitation for symptoms associated with injury, stroke and urinary and fecal incontinence.

Neurofeedback is being used increasingly as an adjunctive therapy for patients (clients) whose primary problems are depression anxiety, attention deficit disorder, emotional instability or a host of psychological and personal problems often treated with psychotherapy alone. 

Therapists and psychiatrists who refer patients for neurofeedback as an adjunctive treatment (meaning in addition to psychotherapy) often report reduced mood swings, less compulsiveness, greater emotional control, clearer thinking and greater stability as results. Therapy goes more quickly when clients are more stable, and better able to cope with and think through problems and therapeutic issues with added support of a treatment which helps stabilize brain function.

As true for neurofeedback used adjunctively for many medical problems, physicians and patients very often report reduced need for and reliance upon medication to control or reduce psychological symptoms as well. There are often corresponding reductions in troublesome and unwanted medication side effects when dosages can be reduced. 

Combining or adding neurofeedback in the treatment of many conditions often speeds overall treatment progress. Although the way in which this comes about is only beginning to be understood scientifically, for the patient, it is more than enough to gain relief, reduce discomfort and know that the treatment itself affords benefit. 

More Information about Neurofeedback:

Click here for an in-depth article about Neurofeedback.

Click here for an article about Neurofeedback and chronic pain.



Who Can Provide Biofeedback and Neurofeedback?

According to Association for Applied Psychophysiology and Biofeedback’s web site (AAPB):

Most states do not restrict who can perform biofeedback services. Thus, a person with no clinical training of any kind or any specialized training in biofeedback may claim to provide biofeedback services.

Many state licensing boards include the practice of biofeedback within the purview of such professions as psychologists, physical therapists, nurses, physicians, etc. Having such a license does not mean that the holder actually has any training or experience in providing biofeedback.

Regardless of a provider’s other credentials, certifications, licenses, etc., the only way for you to have any assurance that the provider can actually perform biofeedback based interventions is if they have had formal training in (a) biofeedback of the type required to treat your problem and (b) training in assessment and treatment of your problem. You can learn about the types of biofeedback used to help numerous disorders by [visiting the AAPB web site,]. Note that people who are trained in providing one type of biofeedback or in providing biofeedback for one disorder frequently know little about providing other types of biofeedback or incorporating biofeedback interventions into the treatment of other disorders.

AAPB feels very strongly that anyone providing biofeedback based services should meet at least the minimum standards of knowledge, training, and experience required to be certified by the Biofeedback Certification Institute of America (BCIA). If a provider is not certified by BCIA, you should be especially cautious when entering into a treatment arrangement. It is important that you determine whether the person is licensed or certified to practice if you are looking for clinical intervention. There are other organizations which do certify people in biofeedback but AAPB has not assessed their criteria for certification.

AAPB (the group which has this web site) is an open membership organization. Anybody can join. Therefore AAPB knows nothing about nor does it certify the competence of any of its members to provide biofeedback services. Any full member (usually a person with a professional degree) without ethical findings against them and, if the person is a clinician, who is licensed or certified by their state to practice can place an advertisement in the provider directory section of the web site so AAPB disclaims any knowledge of any individual’s claims. Providers who are certified by BCIA are listed as such. AAPB provides the provider directory as a public service because it is frequently difficult for the public to locate biofeedback providers for many problems.

More Information:

Click here for an in-depth article about biofeedback practitioners and training.

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