Biofeedback

What is biofeedback?

Biofeedback (biofeedback therapy) is an alternative medicine approach that teaches you to change the way your body functions. It’s a mind-body therapy that may improve your physical and mental health.

During a biofeedback session, a healthcare provider uses noninvasive monitoring equipment and instruments to measure your body’s involuntary functions. This includes things like your heart rate, breathing and muscle tension. Based on feedback from the instruments, your provider suggests how you can create voluntary (conscious) changes for these mostly involuntary functions. With education and practice, you can learn to make those bodily changes without equipment.

Healthcare providers don’t use biofeedback as a standalone treatment for most conditions. But it can help manage symptoms of certain conditions.

Which healthcare providers use biofeedback?

Many different healthcare providers can offer biofeedback therapy, including:

• Psychologists.
• Physical therapists.
• Primary care providers.

Providers who perform biofeedback should be certified by the Association for Applied Psychophysiology and Biofeedback (AAPB) to use the therapy. Make sure your provider has certification before starting therapy.

What conditions can biofeedback help treat?

Studies show that biofeedback therapy may help manage the following conditions:

• Anxiety, depression and post-traumatic stress disorder (PTSD).
• Attention-deficit/hyperactivity disorder (ADHD).
• Chronic fatigue syndrome.
• Chronic pain, including chronic low back pain, chronic pelvic pain and other pain syndromes.
• Constipation.
• Epilepsy.
• Fecal (bowel) incontinence and urinary incontinence.
• Fibromyalgia.
• High blood pressure.
• Insomnia.
• Migraine headaches and tension-type headaches.
• Motion sickness.
• Raynaud’s syndrome.
• Tinnitus.

Healthcare providers don’t use biofeedback therapy as the sole treatment for most of these conditions. They typically require other therapies, like medication or psychotherapy (talk therapy).

What happens during biofeedback therapy?

During a biofeedback session, a certified healthcare provider places painless sensors or devices on your body. The sensors measure physiological signals from your body, such as:

• Breathing with bands around your stomach and chest that have sensors to measure your breathing rate and patterns.
• Heart rate with a pulsometer or sensors connected to an electrocardiogram (EKG).
• Muscle movement and tension using surface electromyography (sEMG), which involves sensors on your skin above certain muscles.
• Sweat with galvanic skin response (GSR) sensors, usually attached to your fingertips and/or palm.
• Electrical brain activity using an electroencephalogram (EEG), which involves sensors attached to your scalp. EEG biofeedback is also called neurofeedback.
• Skin temperature with a skin sensor.

Computers process the information from these sensors or devices and quickly report it back to you. Depending on your type of therapy, you may experience the feedback as:

• Visual, like changing graphics displays or patterns on a screen.
• Auditory, like varying tones or music volume changes.
• Haptic, when you feel vibrations through a wearable device.
• Virtual reality, which may be an interactive video game, for example, which is especially helpful for children.

As you receive the feedback, your provider will explain what it means. Then, they’ll suggest strategies to change how your body is functioning. This will vary depending on your reason for getting biofeedback therapy. For example, your provider may ask you to:

• Change how you sit, stand or move: Positioning your body differently may ease muscle tension.
• Alter your breathing: Breathing patterns can help calm anxiety and lower your heart rate.
• Relax muscles: If you concentrate on relaxing certain groups of muscles, it may relieve pain. This can also help with insomnia.
• Use mindfulness and focus: Thinking about different things can help you control your breathing or slow your heart rate.
• Take a test: If you try to solve a math problem or riddle, you can see how stress affects your body’s response.

As you try each suggestion, you can watch, hear or feel how it affects your body through the feedback device in real time. With practice, you can learn to create the same bodily changes without the feedback device or provider’s prompts.

Can you do biofeedback on yourself?

Once you learn exercises through biofeedback with a certified healthcare provider and monitoring instruments, you can practice the methods at home.

How does biofeedback work?

Biofeedback is essentially a form of operant conditioning. Operant conditioning is a method of learning that uses rewards and punishment to modify behavior. Biofeedback uses visual or auditory (sound) feedback to encourage desired actions. This helps create behavioral changes.

We often don’t consciously realize all the ways our body responds to things like pain, stress and anxiety. If you’re stressed or anxious, for example, your heart and breathing rates may increase, your muscles might become tense and you might start to sweat. With biofeedback, you become aware of these bodily changes and learn to modify them.

Providers choose the best method and technology for producing the most helpful feedback. For example, providers often use electromyography (EMG) biofeedback for muscle-related conditions so you can “see” how your muscles respond.

With these tools, you learn to control bodily functions. You keep practicing these actions — both during sessions with the equipment and at home without equipment — until they become embedded within your memory. After a while, you don’t need the biofeedback instruments to produce the results.

One example of biofeedback is for urinary incontinence and bedwetting (enuresis) in children. A provider places an electrode (sensor) near your child’s anus and on their leg (with consent). A pelvic floor expert then teaches your child pelvic floor exercises. A video game incorporates these exercises. For example, your child plays as a character and has to contract their pelvic floor muscles to avoid obstacles in the game. They also practice pelvic floor exercises at home. This can help improve pelvic floor strength and decrease urinary incontinence.

What are the potential benefits of this treatment?

Biofeedback can help you feel more in control of your health and wellness. With practice during and between sessions, you can learn how to make small changes to relieve stress, improve performance, and ease aches and pains.

But to experience potential benefits, you must actively participate in the therapy and have the motivation to learn and make changes.

What are the risks of this treatment?

There aren’t any risks to biofeedback therapy. It’s noninvasive, and there aren’t any side effects or potential complications.

How often should I do biofeedback therapy?

Some consider biofeedback a type of training, rather than a treatment. For it to work, you must attend multiple sessions. You’ll need to participate actively and practice between appointments.

The number of treatments varies widely, depending on:

• The condition you’re trying to manage.
• The severity of your symptoms.
• How your body responds.
• The amount you practice between sessions.

Your healthcare provider can provide more insight into the frequency of sessions that’s best for you.

When should I call my healthcare provider?

Biofeedback complements medical care — it doesn’t replace it. Most people use biofeedback along with other treatments. For example, someone with chronic pain may take medications and learn biofeedback.

Don’t delay seeing a medical healthcare provider for a health issue, even if biofeedback helps you manage your condition. And keep taking your prescribed medications, no matter how helpful biofeedback is.