What is biofeedback?
Biofeedback is a technique that trains people to improve their health by controlling certain bodily processes that normally happen involuntarily, such as heart rate, blood pressure, muscle tension, and skin temperature. Electrodes attached to your skin, or in some cases, sensors held in your hands, measure these processes and display them on a monitor. With help from a biofeedback therapist, you can learn to change your heart rate or blood pressure, for example. At first you use the monitor to see your progress. But eventually you will be able to achieve success without a monitor or electrodes. Biofeedback is an effective therapy for many conditions, although it is primarily used to treat high blood pressure, tension headache, migraine headache, chronic pain, and urinary incontinence.
Are there different types of biofeedback?
The three most commonly used forms of biofeedback therapy are:
- Electromyography (EMG), which measures muscle tension
- Thermal biofeedback, which measures skin temperature
- Neurofeedback or electroencephalography (EEG), which measures brain wave activity
How does biofeedback work?
Researchers are not sure exactly how or why biofeedback works. However, there does seem to be at least one common thread: most people who benefit from biofeedback have conditions that are brought on or made worse by stress. For this reason, many scientists believe that relaxation is the key to successful biofeedback therapy. When your body is under chronic stress, internal processes like blood pressure become overactive. Guided by a biofeedback therapist, you can learn to lower your blood pressure through relaxation techniques and mental exercises. When you are successful, you see the results on the monitor, which encourages your efforts.
What happens during a biofeedback session?
In a normal biofeedback session, electrodes are attached to your skin. They send information to a small monitor that translates the measurements into either a tone that varies in pitch, a visual meter that varies in brightness, or a computer screen that shows lines moving across a grid. The biofeedback therapist then leads you in mental exercises. Through trial and error, you can soon learn to identify the mental activities that will bring about the physical changes you want.
What is biofeedback good for?
Biofeedback seems to be effective for a range of health problems, such as urinary incontinence, which is a problem for more than 15 million Americans. Some people choose biofeedback over drugs because of the lack of side effects. Based on findings in clinical studies, the Agency for Health Care Policy and Research has recommended biofeedback therapy as a treatment for urinary incontinence. It may also help people with fecal incontinence.
Research also suggests that thermal biofeedback may ease symptoms of Raynaud disease (a condition that causes reduced blood flow to fingers, toes, nose, or ears), while EMG biofeedback has been shown to reduce pain, morning stiffness, and the number of tender points in people with fibromyalgia. A review of scientific clinical studies found that biofeedback may help people with insomnia fall asleep. Other studies suggest it may even reduce the risk of cardiac events by lowering blood pressure levels and reducing the body's "sympathetic" response during times of stress.
Biofeedback can also be used effectively in children. For example, EEG neurofeedback (especially when combined with cognitive therapy) has been reported to improve behavior and intelligence scores in children with attention deficit hyperactivity disorder (ADHD) and autism. Biofeedback, combined with a fiber-rich diet, may help relieve abdominal pain in children. Thermal biofeedback helps relieve migraine and chronic tension headaches among children and teens, as well.
Biofeedback may also be useful for the following health problems:
- Age-related macular degeneration
- Back pain
- Bed wetting
- Chronic pain
- Eating disorders, including anorexia nervosa, bulimia, and overeating
- Epilepsy and related seizure disorders
- Headaches and migraines
- Head injuries
- High blood pressure
- Irritable bowel syndrome (IBS)
- Learning disabilities
- Motion sickness
- Muscle spasms
- Sexual disorders, including pain with intercourse
- Spinal cord injuries
- Muscle pain and immobility
How many sessions will I need?
Each session generally lasts less than 1 hour. The number of sessions required depends on the condition being treated. Many people see results within 8 to 10 sessions. Treatment of headache, incontinence, and Raynaud disease requires at least 10 weekly sessions and some follow up sessions as health improves. However, conditions like high blood pressure usually require 20 weekly biofeedback sessions before you see improvement. You will also be taught mental exercises and relaxation techniques that you can do at home for at least 5 to 10 minutes every day.
Are there any risks associated with biofeedback?
Biofeedback is considered safe. No negative side effects have been reported. If you have serious mental health issues, check with your psychiatrist to make sure you are an appropriate candidate for biofeedback.
How can I find a qualified specialist?
Specialists who provide biofeedback training range from psychiatrists and psychologists to nurses, dentists, and physicians. The Association for Applied Psychology and Biofeedback (www.aapb.org) is a good resource for finding qualified biofeedback practitioners in your area.
Abgrall-Barbry G, Consoli SM. Psychological approaches in hypertension management. Presse Med. 2006;35(6 Pt 2):1088-94.
Amore FM, Paliotta S, Silvestri V, Piscopo P, Turco S, Reibaldi A. Biofeedback stimulation in patients with age-related macular degeneration: comparison between 2 different methods. Can J Ophthalmol. 2013;48(5):431-7.
Andrasik F. Biofeedback in headache: an overview of approaches and evidence. Cleve Clin J Med. 2010;77(3):S72-6.
Ba-Bai-Ke-Re MM, Wen NR, Hu YL, et al. Biofeedback-guided pelvic floor exercise therapy for obstructive defecation: an effective alternative. World J Gastroenterol. 2014;20(27):9162-9.
Blackmore S, Williams D, Wolf S. Skirven: Rehabilitation of the Hand and Upper Extremity. 6th ed. Philadelphia, PA: Elsevier Mosby; 2011.
Bruehl S, Chung OY. Psychological and behavioral aspects of complex regional pain syndrome management. Clin J Pain. 2006;22(5):430-7.
Burgio KL, Goode PS, Urban DA, et al. Preoperative biofeedback assisted behavioral training to decrease post-prostatectomy incontinence: a randomized, controlled trial. J Urol. 2006;175(1):196-201; discussion 201.
Buse DC, Andrasik F. Behavioral medicine for migraine. Neurol Clin. 2009 May;27(2):445-65. Review.
Chiari L, Dozza M, Cappello A, et al. Audio-biofeedback for balance improvement: an accelerometry-based system. IEEE Trans Biomed Eng. 2005;52(12):2108-11.
Chiarioni G, Whitehead WE, Pezza V, et al. Biofeedback is superior to laxatives for normal transit constipation due to pelvic floor dyssynergia. Gastroenterology. 2006;130(3):657-64.
De Leon Rodriguez D, Allet L, Golay A, et al. Biofeedback can reduce foot pressure to a safe level and without causing new at-risk zones in patients with diabetes and peripheral neuropathy. Diabetes Metab Res Rev. 2013;29(2):139-44.
Ernst E. Complementary/alternative medicine for hypertension: a mini-review. Wien Med Wochenschr. 2005;155(17-18):386-91.
George R, Chung TD, Vedam SS, et al. Audio-visual biofeedback for respiratory-gated radiotherapy: Impact of audio instruction and audio-visual biofeedback on respiratory-gated radiotherapy. Int J Radiat Oncol Biol Phys. 2006;65(3):924-33.
Glick RM, Greco CM. Biofeedback and primary care. Prim Care. 2010;37(1):91-103.
He CD, Lang BX, Jin LQ, Li B. Attention deficit hyperactivity disorder treated with scalp acupuncture and EEG biofeedback therapy in children: a randomized controlled trial. Zhongguo Zhen Jiu. 2014;34(12):1179-83.
Heinecke K, Weise C, Rief W. Psychophysiological effects of biofeedback treatment in tinnitus sufferers. Br J Clin Psychol. 2009 Sep;48(Pt 3):223-39. Epub ahead of print.
Hosker G, Cody J, Norton C. Electrical stimulation for faecal incontinence in adults. Cochrane Database Syst Rev. 2007;(3):CD001310.
Husmann DA. Use of sympathetic alpha antagonists in the management of pediatric urologic disorders. Curr Opin Urol. 2006;16(4):277-82.
Jensen MP, Barber J, Romano JM, Hanley MA, Raichle KA, Molton IR, et al. Effects of self-hypnosis training and EMG biofeedback relaxation training on chronic pain in persons with spinal-cord injury. Int J Clin Exp Hypn. 2009 Jul;57(3):239-68.
Kanji N, White AR, Ernst E. Autogenic training for tension type headaches: A systematic review of controlled trials. Complement Ther Med. 2006;14(2):144-50.
Labbe EE. Biofeedback and Cognitive Coping in the Treatment of Pediatric Habit Cough. Appl Psychophysiol Biofeedback. 2006;31(2):167-72.
Linden W, Moseley JV. The efficacy of behavioral treatments for hypertension. Appl Psychophysiol Biofeedback. 2006;31(1):51-63.
Liu J, Zeng J, Wang H, Zhou Y, Zeng C. Effect of pelvic floor muscle training with biofeedback on stress urinary incontinence in postpartum and post-menopausal women. Zhonghua Fu Chan ke Za Zhi. 2014;49(10):754-7.
McGrady A. The results of biofeedback in diabetes and essential hypertension. Cleve Clin J Med. 2010;77(3):S68-71.
Micoulaud-Franchi JA, Lanteaume L, Pallanca O, Vion-Dury J, Bartolomei F. Biofeedback and drug-resistant epilepsy: back to an earlier treatment? Rev Neurol (Paris). 2014;170(3):187-96.
Mullally WJ, Hall K, Goldstein R. Efficacy of biofeedback in the treatment of migraine and tension type headaches. Pain Physician. 2009;12(6):1005-11.
Patcharatrakul T, Gonlachanvit S. Outcome of biofeedback therapy in dyssynergic defecation patients with and without irritable bowel syndrome. J Clin Gastroenterol. 2011;45(7):593-8.
Sugarman LI, Garrison BL, Willford KL. Symptoms as solutions: hypnosis and biofeedback for autonomic regulation in autism spectrum disorders. Am J Clin Hypn. 2013;56(2):152-73.
Sutarto AP, Wahab MN, Zin NM. Resonant breathing biofeedback training for stress reduction among manufacturing operators. Int J Occup Saf Ergon. 2012;18(4):549-61.
Tan G, Thornby J, Hammond DC, Strehl U, Canady B, Arnemann K, Kaiser DA. Meta-analysis of EEG biofeedback in treating epilepsy. Clin EEG Neurosci. 2009 Jul;40(3):173-9.
Terra MP, Dobben AC, Berghmans B, et al. Electrical Stimulation and Pelvic Floor Muscle Training With Biofeedback in Patients With Fecal Incontinence: A Cohort Study of 281 Patients. Dis Colon Rectum. 2006;49(8):1149-59.
Tsai PS, Chang NC, Chang WY, Lee PH, Wang MY. Blood pressure biofeedback exerts intermediate-term effects on blood pressure and pressure reactivity in individuals with mild hypertension: a randomized controlled study. J Altern Complement Med. 2007;13(5):547-54.
Verhagen AP, Damen L, Berger MY, Passchier J, Koes BW. Behavioral treatments of chronic tension-type headache in adults: are they beneficial? CNS Neurosci Ther. 2009 Summer;15(2):183-205.
Woodford H, Price C. EMG biofeedback for the recovery of motor function after stroke. Cochrane Database Syst Rev. 2007;(2):CD004585.